Inpatient Facility Coding & Compliance Alert

Question: I am unable to locate a CPT® code for excision of a recurrent laryngeal nerve schwannoma. The closest code I found is 64790, but this code is for major peripheral nerves. Should I use an unlisted code?

North Dakota Subscriber

Answer: For treating more distally located tumors when the surgeon plans to excise the schwannoma but not any bone, you have several code choices. Appropriate options could include 64788 (Excision of neurofibroma or neurolemmoma; cutaneous nerve), 64790 (... major peripheral nerve) or 64792 (... extensive [including malignant type]). 

Endoscopic removal points you to additional options, depending on the specifics of the case: 31578 (Laryngoscopy, flexible fiberoptic; with removal of lesion), 31540 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis), or 31541 (Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope). 

Best bet: Ask the physician which type of surgery he plans to perform to remove the tumor, so you’ll be better equipped to find the right code or code range for the precertification. Also discuss with the payer whether, because of the location on the laryngeal nerve, you should report “unlisted” nerve code 64999 (Unlisted procedure, nervous system) with supporting documentation, or submit a laryngoscopy code with modifier 22 (Increased procedural service) due to the increased complexity of working around and with the nerve.