Neurosurgery Coding Alert
Look to Excision Cause Before Billing Schwannoma Removal
Question: How should we report an excision/resection of an L5 Schwannoma? We are trying to precertify the surgery, but the surgeon doesn't know which nerve is involved (since he hasn't operated yet).
Delaware Subscriber
Answer: The answer depends on the surgery that the surgeon must perform to excise the tumor. For example, if he plans to perform a laminectomy to remove the tumor, you-ll report either 63277 (Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar), 63282 (... intradural, extramedullary, lumbar), or 63290 (... combined extradural-intradural lesion, any level).
Excision of these tumors is typically reported with one of these codes. However, for more distally located tumors in which the surgeon plans to excise the schwannoma but not any bone, you might report 64788 (Excision of neurofibroma or neurolemmoma; cutaneous nerve), 64790 (... major peripheral nerve) or 64792 (... extensive [including malignant type]).
Ask the physician which type of surgery he plans to perform to remove the tumor, and you-ll be better equipped to find the right code or code range for the precertification.
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