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Transection or avulsion of a cranial nerve, as described by CPT® Code 64771, refers to a surgical procedure that involves the severing or removal of a portion of a cranial nerve. This intervention is typically indicated for the treatment of chronic pain that has not responded to other therapeutic measures. The procedure is specifically performed on cranial or spinal nerves that do not have a more specific coding designation. It is important to note that this surgical intervention occurs outside the dural membrane, which is the protective covering of the brain and spinal cord. The process begins with a skin incision, followed by dissection of the surrounding soft tissues to gain access to the targeted cranial or spinal nerve. Once the nerve is isolated, the transection is executed by grasping the nerve and dividing it. In some cases, the nerve may be avulsed by twisting it over a hemostat, or it may be stretched, ligated, and divided in a sequential manner, first distally and then proximally. Following the transection, the proximal end of the nerve retracts into deeper tissues, and the soft tissues are subsequently closed in layers. For coding purposes, CPT® Code 64771 is specifically designated for the transection or avulsion of a cranial nerve, while CPT® Code 64772 is used for similar procedures involving spinal nerves.
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Transection or avulsion of a cranial nerve is performed for specific indications related to chronic pain management. The following conditions may warrant this surgical intervention:
The procedure for transection or avulsion of a cranial nerve involves several critical steps to ensure proper execution and patient safety. The following outlines the procedural steps:
Post-procedure care for patients who have undergone transection or avulsion of a cranial nerve typically involves monitoring for any immediate complications and managing pain. Patients may experience discomfort at the incision site, and appropriate pain management strategies should be implemented. Follow-up appointments are essential to assess healing and address any concerns that may arise during the recovery process. Additionally, patients may require rehabilitation or physical therapy to aid in recovery and improve functional outcomes.
| Short Descr | SEVER CRANIAL NERVE | Medium Descr | TRANSECTION/AVULSION OTH CRANIAL NRV XDRL | Long Descr | Transection or avulsion of other cranial nerve, extradural | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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 | 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 | 2 | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 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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