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Transection or avulsion of the phrenic nerve is a surgical procedure that involves the severing and/or removal of a portion of the phrenic nerve, which is primarily responsible for controlling the diaphragm and facilitating breathing. This procedure is typically performed to alleviate chronic pain that may be associated with various conditions affecting the diaphragm or surrounding structures. The phrenic nerve originates mainly from the fourth cervical nerve (C4) and also receives contributions from the third (C3) and fifth (C5) cervical nerves. It is important to note that the right and left phrenic nerves have distinct anatomical pathways. The right phrenic nerve is located deep to the scalene muscles in the neck and travels beneath the clavicle, passing through the root of the right lung and reaching the diaphragm at the caval opening, which is situated at the level of the eighth thoracic vertebra. In contrast, the left phrenic nerve follows a similar trajectory along the scalene muscle, entering the thoracic cavity and descending over the left ventricle before reaching the diaphragm. The surgical technique for transection involves grasping the nerve and dividing it, which may be followed by avulsion, where the nerve is twisted over a hemostat to remove it. Alternatively, the procedure may involve stretching, ligating, and dividing the nerve first distally and then proximally, allowing the proximal end of the nerve to retract into deeper tissues. This detailed understanding of the phrenic nerve's anatomy and the surgical approach is crucial for medical coders and billers to ensure accurate coding and billing for this complex procedure.
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The transection or avulsion of the phrenic nerve is indicated for specific conditions that result in chronic pain or dysfunction associated with the diaphragm. The following are the explicitly provided indications for this procedure:
The procedure for transection or avulsion of the phrenic nerve involves several critical steps that ensure the effective severing and/or removal of the nerve. Each step is designed to minimize complications and achieve the desired therapeutic outcome.
Post-procedure care for patients who have undergone transection or avulsion of the phrenic nerve typically involves monitoring for any immediate complications related to the surgery. Patients may experience changes in respiratory function due to the involvement of the phrenic nerve in diaphragm control. It is essential for healthcare providers to assess the patient's recovery and manage any pain or discomfort that may arise following the procedure. Additionally, follow-up appointments may be necessary to evaluate the effectiveness of the procedure in alleviating chronic pain and to monitor for any potential complications.
| Short Descr | INCISE DIAPHRAGM NERVE | Medium Descr | TRANSECTION/AVULSION PHRENIC NERVE | Long Descr | Transection or avulsion of; phrenic nerve | 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) | P1G - Major procedure - Other | 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). | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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) |
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| 2019-01-01 | Note | AMA Guidelines removed. |
| Pre-1990 | Added | Code added. |
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