# Presumed Stitch Neuroma-- Help!!



## ShenVallGal (Aug 25, 2011)

Can anybody help me here?!  This one has me stumped!  There is no path to positively identify the neuroma.  And I can't get the CPT code, either!  I thought maybe 64772, but when I look for information on that code, it all involves the hands and feet!  And if it is, is it times one or two?  Any and all input will be greatly appreciated.  Please!!

"Presumed stitch neuroma, left inguinal region at the site of previous open mesh hernia repair'
Operation Performed:  1.  Open exploration of the left inguinal area.  2.  Ligaclip and segmantal resection of ilioinguinal nerve and iliohypogastric nerve.  3.  Resection of scarified mesh, left inguinal hernia repair site.

Description:  ...persistent pain in the site since his surgery...seems to be localized to a solitary "point" in the midinguinal area.  
Left groin incised with the knife.  Subcutaneous tissues were divided, and external oblique fibers were identified.  Previous closure sutures were identified, and the external oblique fibers were split in a parallel manner, starting cephalad and lateral, through virgin tissue, and extending through the previous closure site.  With gentle retracion, ilioinguinal nerve was identified, and this was found to be extensively involved with the scar reaction and apparent suture closure of the polypropylene mesh.  The nerve was dissected proximally, doubly Liga clipped, and divided.  This was then dissected distally, and the mesh was removed from the anterior abdominal wall with Mayo scissors, elevating it from the underlying soft tissues.  The iliohypogastric nerve was also identified medially, and this was doubly Liga clipped proximally and distally, and segmentally resected.  The scarified mesh and the ilioinguinal nerve were dissected distally and removed from the operative field.  The wound site was irrigated, aspirated, and found to be hemostatic.  The external oblique fibers were then closed in a running manner...fascia was approximated...Monocryl ws used to approximate skin edges...dermabound was applied."


----------



## susanp (Aug 25, 2011)

I think you will have to use the unlisted code 64999 in this case and submit the operative report for review.


----------



## ShenVallGal (Aug 26, 2011)

When I was looking for a code the 64772 was looking right to me because the nerves are from the lumbar plexus, so they are a spinal nerve and outside the dura, but I wanted to check to see that I wasn't misintrepreting the cpt code.  And when I typed in the code, the discussions out there did not have anything to do with the abdomen.  
I haven't billed any codes from the nervous system, so I'm looking for some input, and I will use an unlisted code if I must, but I was trying to see if there was a code out there.

Thanks!


----------

