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Total facial nerve decompression and/or repair, as described by CPT® Code 69955, is a surgical procedure aimed at addressing issues related to the facial nerve, which is crucial for facial movement and sensation. The facial nerve is anatomically divided into three distinct regions: the intracranial, intratemporal, and extratemporal segments. This procedure typically begins with a surgical incision made behind the ear, followed by a mastoidectomy, which is the removal of the mastoid bone to gain access to the facial nerve. The surgeon then carefully exposes the nerve along its vertical segment, reaching the stylomastoid foramen, where the nerve exits the skull. To facilitate this exposure, the surgeon removes the bone overlying the nerve using a surgical burr. The procedure also involves accessing the tympanic cavity through the facial recess, necessitating the removal of additional bone over the tympanic segment of the nerve. The labyrinthine portion of the nerve is subsequently exposed. Depending on the surgical approach, the postauricular incision may be extended in a posterosuperior direction, or an additional incision may be made behind and above the ear to enhance visibility and access. During the procedure, the skin is elevated to reveal the temporal muscle fascia, which is then incised and elevated to allow further access. A temporal bone flap is created and elevated, continuing the dissection to the petrous ridge, where critical anatomical landmarks such as the arcuate eminence and greater petrosal nerve are identified. The surgeon meticulously dissects the bone until reaching the previously accessed tympanic cavity. Once the facial nerve is adequately exposed, it is inspected and tested for functionality. If necessary, neurolysis is performed to free the nerve from any surrounding tissue that may be compressing it. In cases where the nerve sheath is compromised, it may be incised to relieve pressure on the nerve. Any injured segments of the nerve are repaired using fine microfilament sutures, employing specialized microinstruments and an operating microscope to ensure precision. If nerve grafting is indicated, grafts are harvested and utilized to replace the damaged sections of the nerve. Upon completion of the nerve repair, the surgeon addresses any surgical defects in the tympanic cavity and internal auditory canal by repositioning the bone flaps to prevent complications such as herniation of the temporal lobe into the middle ear. Additionally, any dural defects are repaired using temporalis fascia grafting. Finally, the temporal bone flap is replaced and secured with sutures, and the overlying tissues are meticulously closed in layers to promote optimal healing.
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The procedure of total facial nerve decompression and/or repair (CPT® Code 69955) is indicated for various conditions affecting the facial nerve. These indications may include:
The procedure for total facial nerve decompression and/or repair involves several critical steps, each designed to ensure proper access and treatment of the facial nerve. The first step is to make an incision behind the ear, which allows the surgeon to perform a mastoidectomy. This procedure involves the removal of the mastoid bone to gain access to the facial nerve. Following this, the surgeon exposes the nerve along its vertical segment, reaching the stylomastoid foramen, where the nerve exits the skull. Next, the surgeon utilizes a surgical burr to remove the bone that is overlying the nerve, facilitating further access. The tympanic cavity is approached through the facial recess, requiring the removal of additional bone over the tympanic segment of the nerve. The labyrinthine portion of the nerve is then exposed, which may involve extending the postauricular incision in a posterosuperior direction or making a separate incision behind and above the ear to enhance visibility. Once the skin is elevated, the temporal muscle fascia is exposed. The surgeon incises and elevates the muscle and the underlying periosteum to create a temporal bone flap. This flap is then elevated, allowing continued dissection to the petrous ridge, where important anatomical structures such as the arcuate eminence and greater petrosal nerve are identified. The dissection continues until the previously accessed tympanic cavity is reached. At this stage, the facial nerve is inspected and tested for functionality. If neurolysis is necessary, the surgeon performs this procedure to free the nerve from surrounding tissue. In cases where the nerve sheath is compromised, it may be incised to relieve pressure on the nerve. Any injured segments of the nerve are meticulously repaired using fine microfilament sutures, employing microinstruments and an operating microscope for precision. If nerve grafting is required, the surgeon harvests nerve grafts to replace the injured segments. Once the repair is complete, the surgeon addresses any surgical defects in the tympanic cavity and internal auditory canal by repositioning the bone flaps to prevent complications such as herniation of the temporal lobe into the middle ear. Dural defects are repaired using temporalis fascia grafting. Finally, the temporal bone flap is replaced and secured with sutures, and the overlying tissues are closed in layers to promote optimal healing.
After the completion of total facial nerve decompression and/or repair, patients typically require careful monitoring and post-operative care. Expected recovery may vary based on the extent of the procedure and the individual patient's condition. Patients may experience swelling and discomfort in the surgical area, which can be managed with prescribed pain medications. It is essential for patients to follow their surgeon's post-operative instructions, which may include restrictions on physical activity and guidelines for wound care to prevent infection. Follow-up appointments are crucial for assessing the healing process and monitoring the function of the facial nerve. Rehabilitation, including physical therapy, may be recommended to aid in the recovery of facial movement and strength. Overall, the success of the procedure and the recovery process will depend on the specific circumstances surrounding the patient's condition and the surgical intervention performed.
| Short Descr | RELEASE FACIAL NERVE | Medium Descr | TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR | Long Descr | Total facial nerve decompression and/or repair (may include graft) | 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 | 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. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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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