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Neurofibromas are benign tumors that develop from nerve fibers, specifically arising from the proliferation of Schwann cells, which are essential for the formation of the myelin sheath that insulates nerve fibers. These tumors are among the most prevalent types of peripheral nerve tumors and can manifest as solitary growths or, more commonly, in multiples as part of a genetic condition known as neurofibromatosis. Neurofibromatosis is characterized by a wide spectrum of severity, ranging from mild cases with few tumors to severe instances where numerous tumors can lead to significant health complications. While neurofibromas are generally non-cancerous, certain types, such as plexiform neurofibromas, have the potential to undergo malignant transformation, posing a greater risk to the patient. Plexiform neurofibromas are distinguished by their large size and their involvement of a long segment of a nerve or multiple nerves. On the other hand, neurolemmomas, also referred to as schwannomas, are tumors that arise from the outermost sheath of Schwann cells, known as the neurolemma. The procedure described by CPT® Code 64788 involves the excision of a cutaneous nerve neurofibroma or neurolemmoma. This surgical intervention begins with making a skin incision directly over the tumor site, followed by careful dissection to expose the tumor. The tumor is then meticulously separated from the surrounding tissue and excised, after which the incision is closed. This procedure is critical for alleviating symptoms associated with these tumors and preventing potential complications related to their growth.
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Excision of a neurofibroma or neurolemmoma is indicated for various reasons, primarily related to the presence of these tumors on cutaneous nerves. The following conditions may warrant this surgical procedure:
The procedure for excising a cutaneous nerve neurofibroma or neurolemmoma involves several critical steps to ensure successful removal of the tumor while preserving surrounding nerve structures. The following procedural steps are outlined:
After the excision of a neurofibroma or neurolemmoma, patients can expect specific post-procedure care and considerations. The surgical site will require monitoring for signs of infection, such as increased redness, swelling, or discharge. Patients are typically advised to keep the area clean and dry, and to follow any specific wound care instructions provided by the surgeon. Pain management may be necessary, and over-the-counter analgesics or prescribed medications can be used as needed. Follow-up appointments are essential to assess healing and to ensure that there are no complications. Additionally, patients should be informed about the signs of potential recurrence or complications that may require further medical attention.
| Short Descr | REMOVE SKIN NERVE LESION | Medium Descr | EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV | Long Descr | Excision of neurofibroma or neurolemmoma; cutaneous nerve | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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) | 1 - Statutory 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 5 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F1 | Left hand, second digit | F2 | Left hand, third digit | F4 | Left hand, fifth digit | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | F9 | Right hand, fifth digit | FA | Left hand, thumb | GX | Notice of liability issued, voluntary under payer policy | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | T6 | Right foot, second digit | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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