Neurology & Pain Management Coding Alert

Question: I’m trying to obtain preauthorization for percutaneous balloon decompression to treat trigeminal neuralgia. Based on my research, the procedure is considered a mechanical rhizotomy. Would it be correct to submit 64716 or would another code be better?

Massachusetts Subscriber

Answer: Code 64716 (Neuroplasty and/or transposition; cranial nerve [specify]) does not accurately describe the procedure. The medical definition of neuroplasty is surgery to repair or restore nerve tissue. In contrast, balloon decompression is a type of destructive procedure performed by inflating a balloon with enough pressure to damage the trigeminal nerve and block pain signals. Although the destruction codes include chemical, thermal, electrical, and radiofrequency techniques, they are not appropriate for balloon decompression because they don’t specify pressure/mechanical techniques. 

CPT^® does not include a code specifically for percutaneous balloon decompression. Your best option is to report 64999 (Unlisted procedure, nervous system) with documentation of your physician’s service and any supporting information for comparable payment. Some providers use one of the codes from 64600-64610 (Destruction by neurolytic agent, trigeminal nerve …) as a basis for valuation for the unlisted code they report for a percutaneous decompression of the trigeminal nerve. 

Include diagnosis 350.1 for trigeminal neuralgia.