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The obturator nerve is a critical structure that originates from the lumbar plexus, a network of nerves in the lower back. It travels through the pelvis, entering the obturator canal, and extends into the thigh, where it plays a significant role in motor and sensory functions of the lower limb. The procedure described by CPT® Code 64766 involves the transection or avulsion of the obturator nerve within the pelvic cavity, which can be performed with or without an adductor tenotomy. This surgical intervention is typically indicated for conditions that necessitate the disruption of the nerve's function, potentially alleviating pain or addressing other underlying issues. The approach taken in this procedure is intrapelvic, utilizing an extraperitoneal method, which allows for direct access to the nerve while minimizing disturbance to the surrounding abdominal structures. This contrasts with the extrapelvic approach described in CPT® Code 64763, where the procedure is performed outside the pelvic cavity. Understanding the anatomy and pathway of the obturator nerve is essential for healthcare professionals involved in the coding and billing of this procedure, as it ensures accurate representation of the surgical intervention performed.
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The procedure described by CPT® Code 64766 is indicated for specific conditions that may require intervention on the obturator nerve. These indications include:
The procedure for CPT® Code 64766 involves several critical steps to ensure proper access and intervention on the obturator nerve. The steps are as follows:
After the completion of the procedure, appropriate post-operative care is essential for recovery. Patients may be monitored for any complications related to the surgery, such as infection or excessive bleeding. Pain management strategies will be implemented to address any discomfort following the intervention. Additionally, rehabilitation may be necessary to help the patient regain function and adapt to any changes resulting from the nerve transection or avulsion. Follow-up appointments will be scheduled to assess the patient's recovery and the effectiveness of the procedure.
| Short Descr | INCISE HIP/THIGH NERVE | Medium Descr | TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY | Long Descr | Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy | 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) | 0 - Co-surgeons not permitted for this procedure. | 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 | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | 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 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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) |
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| Pre-1990 | Added | Code added. |
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