# resection of neurofibromas



## theralee03 (Apr 21, 2015)

I am having difficulty coding this. I was thinking I would code the lesion in the benign lesion excision cpt code 1140? for each area depending on what the diameters come back on pathology. For the closures I would select the 12036 for all the intermediate closures totaling 24cm.  below is the op note:  

PROCEDURES PERFORMED:
1. Excision of the right distal upper arm neurofibroma, 7 x 1 sq cm,
    with 7 cm intermediate closure.
2. Excision of right elbow neurofibroma, 3 x 1 sq cm, with 3 cm
    intermediate closure.
3. Excision of left thigh neurofibroma, 14 x 5 sq cm, with 14 cm
    intermediate closure.


INDICATIONS FOR PROCEDURE:  This is a 32-year-old female who was seen in
clinic on April 14, 2015, by for evaluation of resection of
neurofibromas located on her trunk and extremities.  She had been
followed routinely by for a neurofibroma on her scalp.  She
states that she has discomfort associated with the lesions located on
her right mid arm and elbow, for a total of 3 lesions, and her left
thigh lesion.  The patient was examined and was determined to be an
appropriate candidate for excision of her left thigh and right arm
neurofibromas.  After risks, benefits, and alternatives were explained
to the patient, the patient elected to proceed with the procedure, and
informed signed consent was obtained.


PROCEDURE IN DETAIL:  After was identified in the preoperative
area by , the patient was brought back to the operating room
and placed supine on the operating table.  SCDs were placed.  The
patient underwent uncomplicated general endotracheal anesthesia
induction.  Preoperative antibiotics were administered.  Next, the
patient's right arm and left thigh were prepped and draped in the usual
sterile fashion.  Prior to initiation of the procedure, an appropriate
time-out was performed confirming the correct patient, operation, and
intended sites.


We began the procedure by turning our attention to the left thigh
lesion.  An ellipse was marked over the left thigh mass measuring 14 x 5 sq cm.   
Next, an incision was made over the marked site using a #10 scalpel
Blade and carried down through the dermis and subcutaneous tissue using electrocautery.   
Hemostasis was obtained.  The mass was then dissected circumferentially  
and was undercut posteriorly and was passed off the operative field.  A 2-0
silk stitch was used to mark the superior aspect of the excision.  The
wound was then copiously irrigated.  Hemostasis was obtained, and the
wound was closed in 3 layers using several interrupted 3-0 Polysorb.
The incision was then closed using interrupted deep dermal 3-0 Polysorb
sutures, and the wound was reapproximated using a running 4-0 Biosyn.
The incision was dressed using Steri-Strips, 4 x 4, and a Tegaderm.


We then turned our attention to the right arm.  An ellipse  
was marked over the distal right upper arm, to encompass two small neurofibromas  
measuring 7 x 1 sq cm.  An incision was then made using a
#10 scalpel blade and carried down through the dermis and
subcutaneous tissue using electrocautery.  Hemostasis was obtained, and
the masses were dissected circumferentially using electrocautery and
undercut posteriorly, freed from the wound and passed off of the
operative field.  A similar elliptical incision measuring 3 x 1 sq cm
was made around the mass located at the posterior elbow, and the mass  
was removed in a similar fashion. Hemostasis was obtained.


The wounds were then closed using several interrupted 3-0 Polysorb
sutures.  The incision was then reapproximated using 4-0 running
Polysorb stitch.  The wounds were then dressed using Steri-Strips, 4 x
4, and Tegaderm.  The patient tolerated this procedure well and was
awoken from anesthesia without complication.  She was taken to the PACU
in stable condition.  All sponge, needle, and instrument counts were
correct x2 at the end of the case, and was present throughout
the entirety of the procedure.


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