Neurology & Pain Management Coding Alert

Question: One of our providers has been treating an established patient for trigeminal neuralgia. The physician was originally treating this condition through medication with clonazepam. Now she is performing radiofrequency neurolysis to temporarily stop the nerve function at the foramen ovale, according to the documentation. I-ve been trying to find a specific code for this procedure, but I keep coming up with general codes for destruction by neurolytic agent, rather than the temporary cessation our provider is performing. Am I missing something?

Florida Subscriber

Answer: You-re already on the right track to finding the correct code. You want to code this procedure based on the nerve the physician is treating. In your case, the best coding choice is 64605 (Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale).

If your provider used some form of radiologic monitoring such as fluoroscopy to perform the trigeminal nerve destruction, the code would change to 64610 (- second and third division branches at foramen ovale under radiologic monitoring).

Why not meds: Patients often fail to find adequate pain relief through medications alone. When drugs don't ease the patient's condition, providers may -- after performing diagnostic injections -- try using more aggressive treatments.

For example: One such treatment is radiofrequency neurolysis, during which the affected nerve is heated using an electrothermal current. This keeps the sensory fibers of the nerve from transmitting pain signals.