Neurology & Pain Management Coding Alert

The American Academy of Neurology (AAN) has reviewed and updated its stance on neuralgia treatment, which means you should be ready for a different set of coding procedures.

The AAN recently released a new guideline for the treatment of trigeminal neuralgia (350.1, Trigeminal neuralgia: tic douloureux, trifacial neuralgia, trigeminal neuralgia NOS) , which states that surgery should be an option for patients suffering from the disease. The new guideline was published in the Aug. 20, 2008 online edition of Neurology.

"There are very few drugs with strong evidence of effectiveness in treating trigeminal neuralgia," says guideline author Gary Gronseth, MD, in a press release. Gronseth is with the University of Kansas in Kansas City and fellow of the American Academy of Neurology. "If people fail to respond to these drugs, physicians should not be reluctant to consider referring the patient for surgery. Often surgery is considered a last resort and patients suffer while the well-intentioned physician tries other medications with limited effectiveness."

The new guideline says that the drugs carbamazepine or oxcarbazepine should be offered as the first treatment option for people with trigeminal neuralgia. "If patients don't respond well to carbamazepine or one or two other drugs, it is reasonable to consider surgery that targets the root of the trigeminal nerve," says Gronseth.

About half of trigeminal neuralgia patients are treated with nerve blocks (64400, Injection, anesthetic agent; trigeminal nerve, any division or branch). Other patients may be treated with radiofrequency neurolysis (64600, Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch; 64605, - second and third division branches at foramen ovale; or 64610, - second and third division branches at foramen ovale under radiologic monitoring).