AHA Coding Clinic® for HCPCS - 2025 Issue 3; Ask the Editor

Decompression of the Femoral and Lateral Femoral Cutaneous Nerves

A patient with compression of the right lateral femoral cutaneous nerve (LFCN) and femoral nerves presents for surgery that includes decompression of the LFCN and femoral nerves in addition to neurolysis of the distal branches. An incision was made through the skin over the LFCN. Using electrocautery, dissection was carried down to the anterior thigh fascia and anterior superior iliac spine. The thigh fascia was incised exposing the musculature and a contused and compressed LFCN that measured approximately 3.5 mm in size. The intrapelvic and extra pelvic portions of the LFCN were decompressed by releasing and dividing fascial bands near the inguinal ligament. Next a medial incision was made over the femoral nerve, dissecting laterally the three femoral nerve branches; vastus lateralis, intermedius, and vastus medialis were dissected free and neurolysis was performed. Additional dissection identified the femoral nerve was running through a separate tunnel compressing the nerve that was just beneath the inguinal ligament. Also noted was a sensory branch, separating into smaller branches which were neurolysed thus decompressing the femoral nerve in the retroperitoneal plane. The decompression extended approximately 5 to 6 cm and dissection was performed separating the muscle fibers and the retroperitoneal fat from the fascial tunnel. The tunnel was fully divided to ensure complete release of the femoral nerve. Due to the fibrous tissue in the area, it was decided to wrap the femoral nerve to minimize the risk of scarring. The warp was placed around the nerve to aid in preventing postoperative scarring and neuritis.What are the correct codes for the decompression of the femoral nerve, the three femoral nerve branches, and the LFCN with its intrapelvic and extra pelvic portions? Is the LFCN decompression inherent in femoral nerve decompression? ...

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