How To Use CPT Code 69745

CPT 69745 describes the procedure of suturing the facial nerve, with or without a graft or decompression, specifically in the intratemporal region. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 69745?

CPT 69745 is used to describe the surgical procedure of suturing the facial nerve within the middle ear, with or without a nerve graft or decompression. This code is specifically used for intratemporal suturing of the facial nerve and should not be confused with extracranial suture of the facial nerve, which has a different CPT code (64864).

2. Official Description

The official description of CPT code 69745 is: ‘Suture facial nerve, intratemporal, with or without graft or decompression; including medial to geniculate ganglion.’ This code is used when the physician performs suturing of the facial nerve within the middle ear, either with or without a nerve graft or decompression. It includes the area medial to the geniculate ganglion.

3. Procedure

1. The patient is positioned supine on the operating table, with the affected temporal bone facing upwards.
2. The physician makes an incision either behind or above the ear, depending on the chosen approach.
3. The skin flap is elevated to expose the temporal muscle.
4. The physician drills over the mastoid until the yellow bone of the otic capsule is identified.
5. The facial nerve is located within the labyrinthine segment.
6. The physician performs suturing of the facial nerve using interrupted sutures.
7. In some cases, nerve grafting or decompression may be performed if necessary.

4. Qualifying circumstances

CPT 69745 is performed on patients who require suturing of the facial nerve within the middle ear. This procedure is typically indicated for patients with specific conditions or injuries affecting the facial nerve in this region. It is important to note that this code is specifically for intratemporal suturing and should not be used for extracranial suturing of the facial nerve.

5. When to use CPT code 69745

CPT code 69745 should be used when a physician performs the intratemporal suturing of the facial nerve, with or without a graft or decompression. It is important to ensure that the procedure is performed within the middle ear and includes the area medial to the geniculate ganglion. If the procedure involves extracranial suturing of the facial nerve, a different CPT code should be used (64864).

6. Documentation requirements

To support a claim for CPT code 69745, the physician must document the following information:

• Patient’s diagnosis or condition necessitating the facial nerve suturing
• Details of the procedure, including whether a graft or decompression was performed
• Location of the incision and approach used
• Specific steps taken during the procedure, such as drilling over the mastoid and locating the facial nerve within the labyrinthine segment
• Any additional procedures performed, such as nerve grafting or decompression
• Any complications or unexpected findings during the procedure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 69745, it is important to ensure that the procedure performed matches the description of the code. The physician should document the specific details of the procedure, including any additional procedures performed, such as nerve grafting or decompression. It is also important to use the appropriate CPT code for extracranial suturing of the facial nerve (64864) if applicable.

8. Historical information

CPT code 69745 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A physician suturing the facial nerve within the middle ear, including medial to the geniculate ganglion, for a patient with facial nerve paralysis.
2. A surgeon performing intratemporal suturing of the facial nerve, with decompression, for a patient with Bell’s palsy.
3. A specialist suturing the facial nerve within the middle ear, with a nerve graft, for a patient with a traumatic facial nerve injury.
4. A physician performing intratemporal suturing of the facial nerve, without graft or decompression, for a patient with facial nerve schwannoma.
5. A surgeon suturing the facial nerve within the middle ear, with decompression and a nerve graft, for a patient with facial nerve neuritis.
6. A specialist performing intratemporal suturing of the facial nerve, without graft or decompression, for a patient with idiopathic facial nerve palsy.
7. A physician suturing the facial nerve within the middle ear, with decompression, for a patient with facial nerve entrapment.
8. A surgeon performing intratemporal suturing of the facial nerve, without graft or decompression, for a patient with facial nerve hemangioma.
9. A specialist suturing the facial nerve within the middle ear, with a nerve graft, for a patient with facial nerve schwannomatosis.
10. A physician performing intratemporal suturing of the facial nerve, without graft or decompression, for a patient with facial nerve neurapraxia.