CPT® Code 27035

Official Description

Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves

Common Language Description

The procedure described by CPT® Code 27035 involves the denervation of the hip joint, specifically targeting the intrapelvic or extrapelvic intra-articular branches of the sciatic, femoral, or obturator nerves. The sciatic nerve originates from the sacral plexus, exiting the pelvis through the greater sciatic foramen and extending down the thigh along the posterior compartment. In contrast, the femoral and obturator nerves arise from the lumbar plexus, with the femoral nerve entering the thigh beneath the inguinal ligament and the obturator nerve traversing the pelvis to enter the thigh through the obturator canal. These nerves can become entrapped between the fascia, leading to significant pain and restricted range of motion in the hip joint. The denervation procedure aims to alleviate this pain by disrupting the nerve pathways that contribute to the discomfort. The approach can be intrapelvic, involving an incision in the lower abdomen to access the nerves, or extrapelvic, where an incision is made over the hip to directly access the affected nerves. In both cases, the procedure involves either dividing the nerve or destroying a portion of it to relieve symptoms associated with nerve entrapment.

1. Indications

The denervation procedure described by CPT® Code 27035 is indicated for patients experiencing significant pain and limited range of motion in the hip joint due to nerve entrapment. The specific conditions that may warrant this procedure include:

Sciatic Nerve Entrapment - Pain resulting from the compression or irritation of the sciatic nerve as it traverses the pelvis and thigh.
Femoral Nerve Entrapment - Symptoms arising from the entrapment of the femoral nerve, which may include pain in the anterior thigh and weakness in knee extension.
Obturator Nerve Entrapment - Pain and dysfunction caused by the compression of the obturator nerve, often leading to adductor weakness and medial thigh pain.

2. Procedure

The denervation procedure can be performed using two distinct approaches: intrapelvic and extrapelvic. Each approach involves specific steps to access and treat the affected nerves.

Intrapelvic Approach - The procedure begins with a skin incision made in the right or left lower quadrant of the abdomen, depending on which hip is affected. The external oblique muscle is then divided above the inguinal ligament to gain access to the underlying structures. Following this, the internal oblique and transverse abdominis muscles are carefully split to expose the peritoneum. The peritoneum and urinary bladder are retracted to allow for clear visibility of the intrapelvic course of the sciatic, femoral, and/or obturator nerves. The surgeon then follows the affected nerve into the intra-articular region of the hip joint, where the nerve is either divided or a portion is destroyed to alleviate pain.
Extrapelvic Approach - In this method, a skin incision is made over the lateral aspect of the hip. The subcutaneous tissues are dissected to reach the articular region of the hip joint. Once the affected nerve is exposed, the surgeon proceeds to divide the nerve or destroy a portion of it, similar to the intrapelvic approach, to relieve the symptoms associated with nerve entrapment.

3. Post-Procedure

After the denervation procedure, patients may require monitoring for any immediate complications related to the surgery. Post-procedure care typically includes pain management and instructions for activity modification to promote healing. Patients are often advised to avoid strenuous activities and may need physical therapy to regain strength and mobility in the hip joint. Follow-up appointments are essential to assess recovery and ensure that the procedure has effectively alleviated the symptoms associated with nerve entrapment.

Short Descr	DENERVATION OF HIP JOINT
Medium Descr	DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH
Long Descr	Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nerves
Status Code	Active Code
Global Days	090 - Major Surgery
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P5B - Ambulatory procedures - musculoskeletal
MUE	1
CCS Clinical Classification	9 - Other OR therapeutic nervous system procedures

51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
AS	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC	This service has been performed in part by a resident under the direction of a teaching physician
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)