# Coding Occipital Neuralgia



## todd5400 (Jul 20, 2012)

I would like a second opinion on coding of this surgery

ICD:  Occipital neuralgia

Procedure:  1. Microsurgical decompression of left occipital nerve
                  2. Ablation of left occipital artery

Patient turned to prone position. After skin incision Doppler was used to find course of occipital artery. The artery was ectatic and markely compressing the occipital nerve which was bowed over considerably. The occipital artery was ablated its entire length where it made contact with the occipital nerve and greatly decompressed the occipital nerve. The fascial verge where the nerve passes through the cervical muscle compartment into the suboccipital region was opened up as well to make sure no compression of nerve.


I was thinking 64722


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## mkmgt001 (Jul 20, 2012)

I would agree with your code choice for a left occipital nerve decompression.  The occipital nerve is considered a spinal nerve, so I think 64722 would be most appropriate.  I'm working on a very similar case, that I'd like an opinion on as well....

I have a provider who is billing CPT 64716 with 20 units.  He is performing decompression of the occipital nerve as well, but he's broken it down by the right & left GREATER occipital nerve, right & left LESSER occipital nerve and right & left DORSAL occipital nerve & he states that multiple areas were decompressed on all of these segments so he came up with 20 units total.  I'm thinking he should have billed CPT 64722 (versus 64716) TWICE for decompression of the right & left occipital nerve...period.  Whether it's the greater, lesser or dorsal segment...it's all the occipital nerve.  Does anyone have any thoughts on that?  Agree/disagree?  Thanks much!!


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## todd5400 (Jul 20, 2012)

I would agree with you in using the 64722 twice - once for right and once for left


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## mkmgt001 (Jul 20, 2012)

I was just looking at the anatomy of the occipital nerves.  It talks about the "greater", "lesser" & "3rd occipital nerve" & from the pictures...these all appear to be totally independent of each other.  I'm thinking about allowing 6 decompressions/neuroplasties (right & left x3), but definitely not 20 like billed. I hope I'm doing this right....


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