General Surgery Coding Alert

Question: A patient has a preoperative diagnosis of chronic pain from the left lower quadrant trocar site (789.04) following a previous procedure. The current operation involves the exploration of the LLQ trocar site with ligation of nerves. Two nerves iliohypogastric and ilioinguinal were transsected through a single incision; no neurofibromas were removed. How should we code the procedure?

Janice Rose, Office Manager
Rose & Thomas, Tazewell, TN

Answer: Without an operative report, it is difficult to definitively answer this question. However, some observations about the coding of such a claim can be made.

A previous procedure was performed on the patient, and now the patient has some pain at the site of the earlier surgery. The second surgery is an attempt to treat the pain.

In this scenario, the correct coding is 64772 (transection or avulsion of other spinal nerve, extradural), says Susan L. Turney, MD, FACP, who represents group practice on the American Medical Associations CPT Advisory Committee.

If two incisions were made to remove the two nerves, the same code could be claimed twice.

If a neurofibroma was removed, code 64788 (excision of neurofibroma or neurolemmoma; cutaneous nerve) should be used.

Turney adds that 64772 is a superficial procedure, and the incision made does not enter deep into the body cavity, so physicians cannot claim for both the incision and the ligation.

In any event, an incision would be bundled into any other work performed by the surgeon, according to HCFAs National Correct Coding Initiative.

Turney says general surgeons may find coding such procedures difficult because they perform them so infrequently.

At the Marshfield (WI) Clinic, where she works, Turney says that not one 64772 procedure had been performed during the first five months of the current fiscal year.