Neurosurgery Coding Alert

Question: What is the correct CPT® code for percutaneous balloon decompression for trigeminal neuralgia?

Florida Subscriber

Answer: This is likely a balloon “compression” of the trigeminal nerve for treating trigeminal neuralgia. CPT® does not include a code specifically for percutaneous balloon decompression. Your best option may be to report an unlisted procedure code, so you can go with 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. You can report the diagnosis with ICD-9 code 350.1 (Trigeminal neuralgia). However, in performing a stereotactic lesion of the trigeminal nerve 61790 (Creation of lesion by stereotactic method, percutaneous, by neurolytic agent [e.g., alcohol, thermal, electrical, radiofrequency]; gasserian ganglion), examples of neurolytic agents included thermal, electrical and radiofrequency options. While this represents a mechanical method for injury, the principles are similar. You may alternatively consider asking the carrier if using the stereotactic code 61790 (if a stereotactic method was used) or the 64600-64610 range of codes can be used.