Wiki Incision/Excision of neurofibroma

[ObGynCPC0910]

I'm struggling with how to code this procedure - can anyone help?

From the op note:
2x1 cm mass on right labia majus ...a scalpel was used to make a small 5 mm incision in the middle of the mass and the neurofibroma was slowly removed through the incision with the scalpel. When the mass was found to be completely removed, the subcutaneous layer was first re-approximated in an interrupted fashion using 2-0 vicryl. The skin layer was then re-approximated in a running fashion with 2-0 vicryl.

Anyone have experience with this or a similar scenario? It's an incision and removal, but I'm not sure how to code that. Benign lesion excision codes (11420) aren't correct, are they? I'm leaning toward 58999 with compare-to code 10121.

 

[Cmama12]

Hi, I don't know much about neurofibromas - however, there are codes specific to them, eg 64788. The lay description references dissecting the mass from the nerve though, and the above documentation does not. Without that detail, I might go with a benign lesion code. Here is what it says for 64788

When the patient is appropriately prepped and anesthetized, the provider incises the skin over the location of the tumor and continues until she exposes the nerve. Using loupe magnification or an operating microscope, she opens the cutaneous nerve and inspects the fascicles and tumor. If the tumor is enveloped with fascicles, she gently separates and elevates the fascicles from the tumor, then carefully removes the tumor from the nerve, preserving the nerve if possible. If the provider is unable to excise the tumor from the nerve, the provider excises the nerve fascicle, too, but preserves remaining nerve fascicles to maintain nerve function. When the procedure is complete, she closes the tissue and the skin.

 

[nielynco]

I'm struggling with how to code this procedure - can anyone help?

From the op note:
2x1 cm mass on right labia majus ...a scalpel was used to make a small 5 mm incision in the middle of the mass and the neurofibroma was slowly removed through the incision with the scalpel. When the mass was found to be completely removed, the subcutaneous layer was first re-approximated in an interrupted fashion using 2-0 vicryl. The skin layer was then re-approximated in a running fashion with 2-0 vicryl.

Anyone have experience with this or a similar scenario? It's an incision and removal,

First, a neurofibroma of the labia is possible, but is very rare. A neurofibroma is not malignant and when located on the labia, would be considered the removal of a benign lesion. You should be looking at 11422 and because he did a layered closure, you can also bill 12041. You should NOT bill code 64778 as the tumor was not found on the nerve. And 10121 would not be correct either as it relates to a foreign body removal, not a lesion removal.

 

[ObGynCPC0910]

Hi, I don't know much about neurofibromas - however, there are codes specific to them, eg 64788. The lay description references dissecting the mass from the nerve though, and the above documentation does not. Without that detail, I might go with a benign lesion code. Here is what it says for 64788

When the patient is appropriately prepped and anesthetized, the provider incises the skin over the location of the tumor and continues until she exposes the nerve. Using loupe magnification or an operating microscope, she opens the cutaneous nerve and inspects the fascicles and tumor. If the tumor is enveloped with fascicles, she gently separates and elevates the fascicles from the tumor, then carefully removes the tumor from the nerve, preserving the nerve if possible. If the provider is unable to excise the tumor from the nerve, the provider excises the nerve fascicle, too, but preserves remaining nerve fascicles to maintain nerve function. When the procedure is complete, she closes the tissue and the skin.

Thanks for responding! I didn't even realize there were codes for neurofibromas. Even though 64788 doesn't fit this procedure, it's a good reminder I need to explore the CPT index better. Thanks again!

 

[ObGynCPC0910]

First, a neurofibroma of the labia is possible, but is very rare. A neurofibroma is not malignant and when located on the labia, would be considered the removal of a benign lesion. You should be looking at 11422 and because he did a layered closure, you can also bill 12041. You should NOT bill code 64778 as the tumor was not found on the nerve. And 10121 would not be correct either as it relates to a foreign body removal, not a lesion removal.

Can I use 11422 if the incision was only 5mm? The space the mass occupied was 2cmx1cm, but he shelled it out of the 5mm incision. (That's the part that's really throwing me.) Thank you for your help! Path just came back on this and it wasn't even a neurofibroma - it's a superficial angiomyxoma - which is also rare.

 

[nielynco]

Can I use 11422 if the incision was only 5mm? The space the mass occupied was 2cmx1cm, but he shelled it out of the 5mm incision. (That's the part that's really throwing me.) Thank you for your help! Path just came back on this and it wasn't even a neurofibroma - it's a superficial angiomyxoma - which is also rare.

It is the size of the lesion plus any margins that determines the code, not the incision size used to remove it. But if he shelled it out, I am surprised he had to do a layered closure considering the area he was working with.