CPT® Code 0419T

Official Description

Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromas

Common Language Description

Destruction of neurofibromas, as indicated by CPT® Code 0419T, refers to the medical procedure aimed at removing extensive cutaneous neurofibromas, which are benign tumors that arise from peripheral nerve cells. These tumors are commonly associated with neurofibromatosis type 1 (NF-1) and type II (NF-2). Neurofibromas can manifest as multiple lesions on the skin, particularly on the face, head, and neck, and may involve more than 50 individual tumors in cases requiring this specific code. The lesions are composed of various cell types, including Schwann cells, mast cells, fibroblasts, and perineural cells, and can lead to symptoms such as pain, itching, bleeding, disfigurement, and functional interference. The procedure for destruction may utilize several techniques, including scraping, shaving, laser cautery, liquid nitrogen, electrosurgery, and desiccation. In particular, the destruction of extensive neurofibromas that extend into the subcutaneous layer is often performed using electrodesiccation, which involves applying an electrical current to dehydrate the lesion. For more superficial lesions, techniques such as fulguration and electrocoagulation may be employed. In cases where the neurofibroma presents as a protruding mass, scraping or shaving the lesion to the skin level followed by electrodesiccation may be necessary to ensure complete removal. This code is specifically designated for procedures involving the destruction of more than 50 neurofibromas located on the face, head, and neck.

1. Indications

The destruction of neurofibromas using CPT® Code 0419T is indicated for patients presenting with extensive cutaneous neurofibromas, particularly those associated with neurofibromatosis type 1 (NF-1) and type II (NF-2). The following conditions warrant this procedure:

Extensive Neurofibromas Presence of more than 50 neurofibromas on the face, head, and neck.
Symptomatic Lesions Neurofibromas causing pain, itching, or bleeding.
Disfigurement Lesions leading to cosmetic concerns or disfigurement.
Functional Interference Neurofibromas that interfere with normal function or movement.

2. Procedure

The procedure for the destruction of neurofibromas involves several key steps, each tailored to effectively remove the lesions while minimizing damage to surrounding tissue. The following procedural steps are typically followed:

Assessment of Lesions The physician begins by thoroughly assessing the extent and characteristics of the neurofibromas. This includes determining the number of lesions, their size, and their depth, particularly noting those that extend into the subcutaneous layer.
Preparation of the Treatment Area The treatment area is then prepared, which may involve cleansing the skin to reduce the risk of infection and marking the lesions for targeted treatment.
Application of Anesthesia Local anesthesia may be administered to ensure patient comfort during the procedure, particularly if multiple lesions are to be treated.
Destruction of Neurofibromas The physician employs electrodesiccation, which involves applying an electrical current to the lesions. This technique dehydrates the neurofibromas, effectively destroying them. For superficial lesions, alternative methods such as fulguration or electrocoagulation may be utilized. In cases where the neurofibromas are protruding, scraping or shaving the lesions to the level of the skin may be performed prior to electrodesiccation to ensure complete removal.
Post-Procedure Care After the destruction of the neurofibromas, the treatment area is typically cleaned, and appropriate dressings may be applied. The physician will provide instructions for post-procedure care to promote healing and minimize complications.

3. Post-Procedure

Post-procedure care following the destruction of neurofibromas is crucial for optimal recovery. Patients are generally advised to keep the treatment area clean and dry, and to follow any specific instructions provided by the physician regarding wound care. It is common for patients to experience some swelling, redness, or discomfort in the treated area, which can typically be managed with over-the-counter pain relief medications. Follow-up appointments may be scheduled to monitor the healing process and assess for any potential complications. Patients should be informed about signs of infection or unusual changes in the treatment area, and advised to contact their healthcare provider if such symptoms occur. Overall, the expected recovery time may vary depending on the extent of the procedure and individual healing responses.

Short Descr	DSTRJ NEUROFIBROMA XTNSV
Medium Descr	DSTRJ NEUROFIBROMA XTNSV FACE HEAD NECK >50
Long Descr	Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); face, head and neck, greater than 50 neurofibromas
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No 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)	0 - Payment restriction for assistants at surgery applies 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	Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator	Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight.
Berenson-Eggers TOS (BETOS)	P1G - Major procedure - Other
MUE	1