LCD/NCD Portal

L29316

 

SURGICAL DECOMPRESSION FOR PERIPHERAL POLYNEUROPATHY

 

 

01/01/2011

 

 

Indications and Limitations of Coverage and/or Medical Necessity

• At present, the preponderance of clinical evidence as noted in various publications in the peer-reviewed literature is NOT sufficient to support the efficacy of surgical decompression of peripheral nerves for the treatment of symptomatic diabetic metabolic, inflammatory or toxic polyneuropathy.

o Therefore, this Local Coverage Determination (LCD) finds surgical decompression of peripheral nerves as NOT reasonable and necessary and therefore not eligible for reimbursement by Medicare.

 

 

CPT/HCPCS Codes

 

01470 ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG, ANKLE, AND FOOT; NOT OTHERWISE SPECIFIED

28035 RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)

64702 NEUROPLASTY; DIGITAL, 1 OR BOTH, SAME DIGIT

64704 NEUROPLASTY; NERVE OF HAND OR FOOT

64708 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED

64712 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; SCIATIC NERVE

64714 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; LUMBAR PLEXUS

64722 DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)

64726 DECOMPRESSION; PLANTAR DIGITAL NERVE

64727 INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS)

 

 

ICD-9 Codes that DO NOT Support Medical Necessity

 

250.60 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.61 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], NOT STATED AS UNCONTROLLED

250.62 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.63 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE I [JUVENILE TYPE], UNCONTROLLED

356.4 IDIOPATHIC PROGRESSIVE POLYNEUROPATHY

356.8 OTHER SPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY

356.9 UNSPECIFIED IDIOPATHIC PERIPHERAL NEUROPATHY

357.1 POLYNEUROPATHY IN COLLAGEN VASCULAR DISEASE

357.2 POLYNEUROPATHY IN DIABETES

357.3 POLYNEUROPATHY IN MALIGNANT DISEASE

357.4 POLYNEUROPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE

357.5 ALCOHOLIC POLYNEUROPATHY

357.6 POLYNEUROPATHY DUE TO DRUGS

357.7 POLYNEUROPATHY DUE TO OTHER TOXIC AGENTS

357.81 CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS

 

 

Treatment Logic

• Peripheral polyneuropathy leads to damage of the nerves in the arms and legs, with the feet and legs usually affected before the hands and arms.

o Symptoms of peripheral neuropathy, which are often worse at night, may include numbness or insensitivity to pain or temperature, tingling, burning, or prickling sensations, sharp pains or cramps, extreme sensitivity to touch and loss of balance coordination.

 

 

Sources of Information and Basis for Decision

 

Chaudhry V, Stevens J, Kincaid J, So Y..(2006) Practice advisory: utility of surgical decompression for treatment of diabetic neuropathy: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2006; 66: 1805-1808.

 

Investigations in Patients with Neuropathy Noble: Textbook of Primary Care Medicine, 3rd ed. 2001 Mosby, Inc. retrieved From MD Consult

 

Kale B, Yϋksel F, Bahattin Ç,et al. Effect of various nerve decompression procedures on the functions of distal limbs in streptozotocin-induced diabetic rats further optimism in diabetic neuropathy. Plastic and Reconstructive Surgery 2003;111(7):2265-2272.

 

Lee CH, Dellon AL. Prognostic ability of tinel sign in determining outcome for decompression surgery in diabetic and non-diabetic neuropathy. Ann Plast Surg 2004;53: 523-527.

 

Scientific Basis for Nerve Compression in Diabetic Neuropathy retrieved from internet February 19, 2007.

 

01/01/2011

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

CMS LCD SURGICAL DECOMPRESSION FOR PERIPHERAL POLYNEUROPATHY