Neurology & Pain Management Coding Alert

Learn about nerve structure to help ensure correct codes Understanding the facial nerve structure and paying attention to all possible treatments the patient might have will help you submit correct claims for your neurologist's services when he treats trigeminal neuralgia.

Understand What's Happening The trigeminal nerves provide all sensation to the face, teeth, mouth, sinuses, meninges (coverings of the brain) and blood vessels of the head. And trigeminal neuralgia (also known as tic douloureux) is an extremely painful condition affecting the face.

A trigeminal nerve is on each side of the head, with each separating into three branches. Patients feel trigeminal pain in the area reached by one or more of these branches in the upper, middle or lower part of the face. Trigeminal neuralgia usually occurs on one side of the face, although some patients experience it on both sides of the face at the same time.
 
-In essence, this is a disorder of the fifth cranial nerve, or trigeminal nerve,- says Franz Ritucci, MD, director of the American Academy of Ambulatory Care in Orlando, Fla. -It produces severe pain episodes that may last for seconds or minutes. Patients have numerous attacks--sometimes hundreds--a day.-

Deep, burning pain may continue between the jolts or may disappear. Even simple activities such as chewing, talking, shaving or having cold wind blown on the face can trigger the attacks.  Look to MRI, CT, MRA as Diagnostic Tests Ruling out other pain-causing conditions (such as a neoplasm between the cerebellum and pons) is one of the first steps toward diagnosing trigeminal neuralgia. Physicians often rely on MRI (magnetic resonance imaging), CT (computed tomography) or MRA (magnetic resonance angiogram) scans to assess the patient's condition. Neurologists usually send patients to a radiology facility for MRI, CT and MRA tests. Keep the procedure codes in mind, however, because you might report them with modifier 26 (Professional component) if your physician interprets the results:

- 70551 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; without contrast material), 70552 (- with contrast material[s]) or 70553 (- without contrast material, followed by contrast material[s] and further sequences) for MRI

- 70450 (Computed tomography, head or brain; without contrast material), 70460 (- with contrast material[s]) or 70470 (- without contrast material, followed by contrast material[s] and further sections) for CT

- 70544 (Magnetic resonance angiography, head; without contrast material[s]), 70545 (- with contrast material[s]) or 70546 (- without contrast material[s], followed by contrast material[s] and further sequences) for MRA. In most situations, physicians say MRI is a better diagnostic tool than a CT scan. Conducting an MRI with and without contrast is the best option, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the [...]