Pain Management Coding Alert

Question: An established patient with trigeminal neuralgia reports to the PM physician complaining of facial pain. After a level-three evaluation and management (E/M) service, the physician performs destruction of the trigeminal nerve. How should I report this encounter?

Indiana Subscriber

Answer: Your final code choice will depend on which branch of the trigeminal nerve the physician destroyed. Go back and check the encounter notes, and choose one of the following codes depending on encounter specifics:

• 64600 — Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch
• 64605 —  … second and third division branches at foramen ovale
• 64610 — … second and third division branches at foramen ovale under radiologic monitoring.

No matter which of the above codes you choose, you’ll append G50.0 (Trigeminal neuralgia) to the procedure code to represent the patient’s condition. Also append G50.0 to 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity … ) for the E/M service, with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to show that the E/M and nerve destruction were significant, separately identifiable services.

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