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Neurofibromas are tumors that develop from nerve fibers, specifically arising from the proliferation of Schwann cells, which are essential for the proper functioning of peripheral nerves. 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 limited tumor formation to severe instances where numerous tumors can lead to significant health complications. While most neurofibromas are benign, certain types, such as plexiform neurofibromas, have the potential to undergo malignant transformation, posing a greater risk to the patient. Plexiform neurofibromas are particularly notable as they involve a long segment of a nerve or multiple nerves, complicating their management. On the other hand, neurolemmomas, also known as schwannomas, are tumors that arise from the outer sheath of Schwann cells, known as the neurolemma. The excision of these tumors, particularly extensive or malignant types, is addressed under CPT® Code 64792. This procedure involves a surgical approach similar to that used for less extensive tumors, but it may require more comprehensive dissection and the removal of multiple tumors within the same area or the excision of malignant lesions, ensuring thorough treatment of the affected nerve structures.
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The excision of neurofibromas or neurolemmomas, particularly extensive or malignant types, is indicated for patients presenting with the following conditions:
The procedure for excising extensive or malignant neurofibromas or neurolemmomas follows a systematic approach, similar to that used for less extensive tumors, but with additional considerations for the complexity of the case.
Post-procedure care is essential for optimal recovery following the excision of extensive or malignant neurofibromas or neurolemmomas. Patients are typically monitored for any immediate complications, such as bleeding or infection. Pain management is provided as needed, and patients may be advised to limit physical activity to facilitate healing. Follow-up appointments are crucial to assess the surgical site, monitor for any signs of recurrence, and ensure proper nerve function is maintained. Patients may also receive guidance on wound care and signs of complications to watch for during their recovery period.
| Short Descr | REMOVAL OF NERVE LESION | Medium Descr | EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV | Long Descr | Excision of neurofibroma or neurolemmoma; extensive (including malignant type) | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| 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. | 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). | 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. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | ET | Emergency services | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 2017-01-01 | Changed | Guidelines added. |
| Pre-1990 | Added | Code added. |
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