D.R.
Networker
Please help..... my provider wants to submit 64708 & +64787. Add on code, 64787 can only be billed w/ 64774-64786. The note clearly states that the neuroma was not excised. I agree with 64708 but I would appreciate any help .
The proximal end of the prior incision along the lateral leg was reopened and skin flaps were elevated. The peroneal nerve was identified proximal to the fibular head, heavily encased in scar tissue. It was freed circumferentially and dissected distally until the scar became very thick and the nerve flattened. Distally, muscle was elevated, and the nerve was identified where it split into sensory and motor branches deep to the muscle. The superior and inferior/lateral edges were visible and the nerve was dissected proximally. There was a large neuroma just distal to the fibular head. Because the patient has recently started to gain ankle extension, I chose to not excise the neuroma in continuity, but, instead, to do internal neurolysis. On the surface, longitudinal dissection with a knife was performed through the superficial scar to also expose fascicles. A segment of scar was sent to identify neuroma vs scar. The nerve was rotated to visualize the deep side. Sharp dissection was used to free groups of fascicles from each other. A thin segment of free muscle was harvested from the anterior aspect of the leg, expanded, and lain over the dissected nerve. It was tacked to surrounding scar tissue to allow it to continue to glide. The muscle will hopefully decrease neuropathic pain and to provide a layer of tissue between the nerve and skin. The tourniquet was released. Bleeding was controlled with bipolar electrocautery. The wound was closed in a layered fashion with dermal monocryl and cutaneous prolene
The proximal end of the prior incision along the lateral leg was reopened and skin flaps were elevated. The peroneal nerve was identified proximal to the fibular head, heavily encased in scar tissue. It was freed circumferentially and dissected distally until the scar became very thick and the nerve flattened. Distally, muscle was elevated, and the nerve was identified where it split into sensory and motor branches deep to the muscle. The superior and inferior/lateral edges were visible and the nerve was dissected proximally. There was a large neuroma just distal to the fibular head. Because the patient has recently started to gain ankle extension, I chose to not excise the neuroma in continuity, but, instead, to do internal neurolysis. On the surface, longitudinal dissection with a knife was performed through the superficial scar to also expose fascicles. A segment of scar was sent to identify neuroma vs scar. The nerve was rotated to visualize the deep side. Sharp dissection was used to free groups of fascicles from each other. A thin segment of free muscle was harvested from the anterior aspect of the leg, expanded, and lain over the dissected nerve. It was tacked to surrounding scar tissue to allow it to continue to glide. The muscle will hopefully decrease neuropathic pain and to provide a layer of tissue between the nerve and skin. The tourniquet was released. Bleeding was controlled with bipolar electrocautery. The wound was closed in a layered fashion with dermal monocryl and cutaneous prolene