mtimson
Contributor
I'm needing some help in finding the right code for this procedure:
The patient was placed with the face turned to the left side. Fluoroscopic monitoring identified the foramen ovale. An entry point was selected 15 mm lateral to the angle of the mouth. This was infiltrated with 7 cc of 0.5% Xylocaine. An entry point was made with a 16-gauge needle. Through this entry point, an electrode was advanced towards the foramen ovale. An electrode was selected with a 5-mm exposed tip. The electrode was advanced and engaged the foramen ovale. It was advanced further until the tip was in line with the clivus, as confirmed with fluoroscopy. Intraoperative stimulation produced paresthesias in the distribution of the chin and the jaw, but never in the forehead or periorbital region. A series of lesions were made to 50°, 60°, 70°, 80°, and 90°C, each for the same period of time of 50, 60, 70, 80, and 90 seconds. Between lesions, stimulation was again repeated to confirm the paresthesias covering the area involved with pain.
Finally, the electrode was withdrawn 2 mm but remained engaged in Meckel's cave. The last lesion was made to 80°C for 80 seconds. Once the last lesion was performed, the electrode was withdrawn.
Because it was not done stereotatic method I DO NOT think I can use code 61791. However I also don't see where 64610 would be correct either because they are treated this by creating lesions not "destruction of". Which leads me to unlisted 64999
I'd really appreciate any feedback on this. Thank you!
~Marty
The patient was placed with the face turned to the left side. Fluoroscopic monitoring identified the foramen ovale. An entry point was selected 15 mm lateral to the angle of the mouth. This was infiltrated with 7 cc of 0.5% Xylocaine. An entry point was made with a 16-gauge needle. Through this entry point, an electrode was advanced towards the foramen ovale. An electrode was selected with a 5-mm exposed tip. The electrode was advanced and engaged the foramen ovale. It was advanced further until the tip was in line with the clivus, as confirmed with fluoroscopy. Intraoperative stimulation produced paresthesias in the distribution of the chin and the jaw, but never in the forehead or periorbital region. A series of lesions were made to 50°, 60°, 70°, 80°, and 90°C, each for the same period of time of 50, 60, 70, 80, and 90 seconds. Between lesions, stimulation was again repeated to confirm the paresthesias covering the area involved with pain.
Finally, the electrode was withdrawn 2 mm but remained engaged in Meckel's cave. The last lesion was made to 80°C for 80 seconds. Once the last lesion was performed, the electrode was withdrawn.
Because it was not done stereotatic method I DO NOT think I can use code 61791. However I also don't see where 64610 would be correct either because they are treated this by creating lesions not "destruction of". Which leads me to unlisted 64999
I'd really appreciate any feedback on this. Thank you!
~Marty