CPT® Code 0420T

Official Description

Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromas

Common Language Description

The CPT® Code 0420T refers to the destruction of extensive cutaneous neurofibromas, specifically when there are more than 100 lesions present on the trunk and extremities. Neurofibromas are benign tumors that arise from peripheral nerve cells and are commonly associated with neurofibromatosis type 1 (NF-1) and type II (NF-2). These tumors can contain various cell types, including Schwann cells, mast cells, fibroblasts, and perineural cells. Clinically, neurofibromas can lead to a range of symptoms such as pain, itching, bleeding, disfigurement, and functional interference, which can significantly impact a patient's quality of life. The procedure for destruction of these lesions can involve multiple techniques, including scraping, shaving, laser cautery, liquid nitrogen application, electrosurgery, and desiccation. The method chosen often depends on the extent and depth of the lesions. For extensive neurofibromas that extend into the subcutaneous layer, electrodesiccation is commonly utilized, where an electrical current is applied to dehydrate the lesion. For more superficial lesions, techniques such as fulguration and electrocoagulation may be appropriate. In cases where the neurofibroma presents as a protruding mass, a combination of scraping or shaving followed by electrodesiccation may be employed to effectively remove the deeper layers of the tumor. It is important to note that for the destruction of fewer than 100 neurofibromas located on the face, head, and neck, CPT® Code 0419T should be used instead.

1. Indications

The destruction of extensive cutaneous neurofibromas, as indicated by CPT® Code 0420T, is performed for patients presenting with a significant number of neurofibromas on the trunk and extremities. The following conditions and symptoms may warrant this procedure:

Neurofibromatosis Type 1 (NF-1) - A genetic disorder characterized by the presence of multiple neurofibromas, which can lead to cosmetic concerns and discomfort.
Neurofibromatosis Type 2 (NF-2) - Another genetic condition that may present with neurofibromas, necessitating removal for similar reasons as NF-1.
Disfigurement - The presence of numerous neurofibromas can lead to significant cosmetic issues, prompting patients to seek removal for aesthetic reasons.
Functional Interference - Neurofibromas may cause physical discomfort or functional limitations, particularly if they are located in areas subject to friction or pressure.
Symptoms of Pain or Itching - Patients may experience discomfort, including pain or itching, which can be alleviated through the destruction of the lesions.

2. Procedure

The procedure for the destruction of extensive neurofibromas involves several key steps, which are detailed below:

Assessment of Lesions - The physician begins by thoroughly assessing the number, size, and location of the neurofibromas on the trunk and extremities to determine the most appropriate treatment approach.
Preparation of the Treatment Area - The treatment area is cleaned and prepared to minimize the risk of infection. Local anesthesia may be administered to ensure patient comfort during the procedure.
Application of Electrodesiccation - For extensive neurofibromas, electrodesiccation is typically employed. An electrical current is applied to the lesions, which causes dehydration and destruction of the tumor tissue. This method is particularly effective for lesions that extend into the subcutaneous layer.
Utilization of Additional Techniques - Depending on the characteristics of the neurofibromas, additional techniques such as scraping or shaving may be used, especially for protruding lesions. After initial removal, electrodesiccation is applied to ensure complete destruction of deeper layers.
Post-Procedure Care - After the destruction of the neurofibromas, the treatment area is monitored for any immediate complications. Instructions for post-procedure care, including wound care and signs of infection, are provided to the patient.

3. Post-Procedure

Post-procedure care is essential for optimal recovery following the destruction of neurofibromas. Patients are typically advised to keep the treatment area clean and dry to prevent infection. They may be instructed to avoid strenuous activities and sun exposure during the initial healing phase. Follow-up appointments may be scheduled to monitor the healing process and assess for any recurrence of neurofibromas. Patients should also be informed about potential side effects, such as swelling, redness, or discomfort at the treatment site, which are generally temporary and resolve with time. If any unusual symptoms arise, such as increased pain or signs of infection, patients are encouraged to contact their healthcare provider promptly.

Short Descr	DSTRJ NEUROFIBROMA XTNSV
Medium Descr	DSTRJ NEUROFIBROMA XTNSV TRNK EXTREMITIES >100
Long Descr	Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 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