I swear I have scoured the web for a clue but have had no luck. Have any of you ever coded one of these or had experience coding something similar?
How would you guys code for a vidian neurectomy?
- Thread starter earboy
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I'm pretty sure you are stuck with an unlisted code. The only sinonasal endoscopic surgical codes in my CPT coding book are (as I recall).
the standard FESS codes (anterior ethmoidectomy, etc.)
biopsy/polypectomy/debridement code
concha bullosa
DCR
orbital decompression codes
balloon codes
the standard FESS codes (anterior ethmoidectomy, etc.)
biopsy/polypectomy/debridement code
concha bullosa
DCR
orbital decompression codes
balloon codes
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Use the PPF code, any approach.
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I agree with above about an unlisted procedure. Do you kind giving details on this pt's history and insurance carrier? Is this procedure covered or is it considered experimental/investigational? Just curious.
Also, I found the following code which may be applicable although it seems to be an open procedure rather than endoscopic:
64771
Transection or avulsion of other cranial nerve, extradural
Lay Description
The physician cuts or avulses another cranial nerve, such as branch nerves of major nerves not listed in previous codes. The physician makes an incision on the face or neck overlying the extradural portion of the other cranial nerve. The tissues are dissected and the nerve is exposed. The nerve is destroyed. The incision is sutured in layers.
Also, I found the following code which may be applicable although it seems to be an open procedure rather than endoscopic:
64771
Transection or avulsion of other cranial nerve, extradural
Lay Description
The physician cuts or avulses another cranial nerve, such as branch nerves of major nerves not listed in previous codes. The physician makes an incision on the face or neck overlying the extradural portion of the other cranial nerve. The tissues are dissected and the nerve is exposed. The nerve is destroyed. The incision is sutured in layers.
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Hmmm.
An intelligent coder would nix that code since there is no incision and it is considered a code for an open procedure. You could use the unlisted code but since it's a hassle and requires approvals and letters, why bother? PPF code works.
An intelligent coder would nix that code since there is no incision and it is considered a code for an open procedure. You could use the unlisted code but since it's a hassle and requires approvals and letters, why bother? PPF code works.
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Good call, NPB.
Code Description
31040
Pterygomaxillary fossa surgery, any approach
Lay Description
The physician opens the pterygopalatine space to access the nerves or blood vessels located within the fossa. An intraoral incision is made in the maxillary buccal vestibule. An opening is made in the anterior maxillary wall with drills and chisels. Electrocautery of the sinus membrane of the posterior maxillary wall is performed to control bleeding. Chisels create an opening in the posterior maxillary wall. This bone is removed, providing an entrance into the pterygopalatine space. Fat is abundant and protects the fossa's vidian nerve, the sphenopalatine ganglion, and the branches of the internal maxillary artery. These structures are dissected free from fat and may be ligated and sectioned. The intraoral incision is closed in a single layer.
Code Description
31040
Pterygomaxillary fossa surgery, any approach
Lay Description
The physician opens the pterygopalatine space to access the nerves or blood vessels located within the fossa. An intraoral incision is made in the maxillary buccal vestibule. An opening is made in the anterior maxillary wall with drills and chisels. Electrocautery of the sinus membrane of the posterior maxillary wall is performed to control bleeding. Chisels create an opening in the posterior maxillary wall. This bone is removed, providing an entrance into the pterygopalatine space. Fat is abundant and protects the fossa's vidian nerve, the sphenopalatine ganglion, and the branches of the internal maxillary artery. These structures are dissected free from fat and may be ligated and sectioned. The intraoral incision is closed in a single layer.
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The "any approach" usually gets it by the coders. I've used it for laterally based approaches or when I've worked in there after the H&N guys have done maxillectomies.
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Maybe it's under coding but I called it a 31238-22. I ended up doing a posterior nasal neurectoly which is akin to an endoscopic SPA ligation. Thanks for the help. I hate unlisted codes but they can also be financially beneficial as in the case of sialendoscopy.
