I am not well versed in nerve repair coding could I get some help on the following situation:
" I then used meticulous dissection technique to isolate the dorsal sensory branch of the radial nerve as it was emanating from the arm next to the brachioradialis. I then proceeded to identify the branches of the nerve distally at the base of the thumb. The area around the schwannoma itself was very scarred in. The schwannoma was about 3 cm in diameter. After very meticulous dissection of all the nerve branches, I identified 3 large nerve branches from the dorsal sensory nerve. The 2 largest branches were going directly towards the schwannoma.
At this point, I brought in the operating room microscope to complete the dissection. I performed an internal neurolysis of the dorsal sensory nerve to isolate these 2 nerve branches. The first nerve branch was scarred down to the lower portion of the schwannoma. However, using careful internal neurolysis under the operating room microscope, I was able to separate the fascicles of this first branch. I also separated these branches from the surrounding scar tissue. I then turned my attention to the second sensory nerve branch headed towards the schwannoma. This nerve branch was going directly into the center of the schwannoma. I did not feel that it was possible to separate these fascicles from the schwannoma. As a result I completely excised this segment of nerve including the schwannoma as a whole. This left a 3 cm nerve gap. Therefore I turned my attention to reconstruction of this nerve. I used a 2 mm x 5 cm Axogen nerve allograft to reconstruct this. I trimmed this nerve to the exact 3 cm required for a tension-free repair. Once this was done I inset the nerve allograft into the desired location and sewed it to the dorsal sensory branch under the operating room microscope. I used #9-0 suture and placed approximately 6 epineurial stitches both proximally and distally. In order to minimize scarring around both this nerve and the previously neuro lysed nerve branch, I used an Axogen and nerve wrap around both individually.
Once this was done I turned my attention to the skin closure. "
My thoughts are:
64708, 64727 (1st nerve branch), 64910-xs for the allograft on the other nerve branch and 29075 for the splint.
I know both branches are of the radial nerve, but I thought because the work for the neurolysis was on 1 branch and the allograft on another that then they could be billed together with a modifier.
Thanks for any help!
-Autumn
" I then used meticulous dissection technique to isolate the dorsal sensory branch of the radial nerve as it was emanating from the arm next to the brachioradialis. I then proceeded to identify the branches of the nerve distally at the base of the thumb. The area around the schwannoma itself was very scarred in. The schwannoma was about 3 cm in diameter. After very meticulous dissection of all the nerve branches, I identified 3 large nerve branches from the dorsal sensory nerve. The 2 largest branches were going directly towards the schwannoma.
At this point, I brought in the operating room microscope to complete the dissection. I performed an internal neurolysis of the dorsal sensory nerve to isolate these 2 nerve branches. The first nerve branch was scarred down to the lower portion of the schwannoma. However, using careful internal neurolysis under the operating room microscope, I was able to separate the fascicles of this first branch. I also separated these branches from the surrounding scar tissue. I then turned my attention to the second sensory nerve branch headed towards the schwannoma. This nerve branch was going directly into the center of the schwannoma. I did not feel that it was possible to separate these fascicles from the schwannoma. As a result I completely excised this segment of nerve including the schwannoma as a whole. This left a 3 cm nerve gap. Therefore I turned my attention to reconstruction of this nerve. I used a 2 mm x 5 cm Axogen nerve allograft to reconstruct this. I trimmed this nerve to the exact 3 cm required for a tension-free repair. Once this was done I inset the nerve allograft into the desired location and sewed it to the dorsal sensory branch under the operating room microscope. I used #9-0 suture and placed approximately 6 epineurial stitches both proximally and distally. In order to minimize scarring around both this nerve and the previously neuro lysed nerve branch, I used an Axogen and nerve wrap around both individually.
Once this was done I turned my attention to the skin closure. "
My thoughts are:
64708, 64727 (1st nerve branch), 64910-xs for the allograft on the other nerve branch and 29075 for the splint.
I know both branches are of the radial nerve, but I thought because the work for the neurolysis was on 1 branch and the allograft on another that then they could be billed together with a modifier.
Thanks for any help!
-Autumn