How To Use CPT Code 64790

CPT 64790 describes the excision of a neurofibroma or neurolemmoma, which is a tumor growing along or in the nerve sheath of a major peripheral nerve. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64790?

CPT 64790 can be used to describe the excision of a neurofibroma or neurolemmoma, which are tumors that grow along or in the nerve sheath of a major peripheral nerve. This code is used when a provider surgically removes the tumor from the nerve, preserving the nerve if possible.

2. Official Description

The official description of CPT code 64790 is: ‘Excision of neurofibroma or neurolemmoma; major peripheral nerve.’

3. Procedure

1. When performing CPT 64790, the provider begins by prepping and anesthetizing the patient.
2. An incision is made over the location of the tumor, and the provider continues until the nerve is exposed.
3. Using magnification tools like loupe magnification or an operating microscope, the provider opens the major peripheral nerve and inspects the fascicles and tumor.
4. If the tumor is enveloped with fascicles, the provider gently separates and elevates the fascicles from the tumor.
5. The tumor is carefully removed from the nerve, with the goal of preserving the nerve if possible.
6. If the provider is unable to excise the tumor from the nerve without compromising nerve function, they may cautiously excise the affected nerve fascicle while preserving the remaining nerve fascicles.
7. If there is a concern about a loss of function, the provider may use electrical stimulation to test the fascicles affected by the tumor and may harvest and suture nerve grafts as necessary.
8. Once the excision is complete, the provider closes the tissue and the skin.

4. Qualifying circumstances

CPT 64790 is performed on patients with a tumor growing along or in the nerve sheath of a major peripheral nerve. The provider must carefully assess the patient’s condition and determine the need for excision. The procedure is typically performed by a qualified healthcare professional who has the necessary expertise in neurosurgery or a related field.

5. When to use CPT code 64790

CPT code 64790 should be used when a provider performs the excision of a neurofibroma or neurolemmoma from a major peripheral nerve. It is important to accurately document the location and nature of the tumor to support the use of this code.

6. Documentation requirements

To support a claim for CPT 64790, the provider must document the following information:

• Patient’s diagnosis and the need for excision
• Details of the procedure, including the location of the tumor and the nerve involved
• Use of magnification tools, such as loupe magnification or an operating microscope
• Steps taken to preserve the nerve, if possible
• Use of electrical stimulation, if applicable
• Any nerve grafts harvested and sutured
• Closure of the tissue and skin

7. Billing guidelines

When billing for CPT 64790, ensure that the excision is performed on a major peripheral nerve and that the documentation supports the use of this code. It is important to follow the specific guidelines provided by the payer and to accurately report any additional procedures or services performed during the same encounter.

8. Historical information

CPT 64790 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A neurosurgeon performing the excision of a neurofibroma from the sciatic nerve of a patient.
2. An orthopedic surgeon removing a neurolemmoma from the ulnar nerve of a patient’s arm.
3. A plastic surgeon excising a neurofibroma from the facial nerve of a patient.
4. A neurologist performing the excision of a neurolemmoma from the radial nerve of a patient’s forearm.
5. A general surgeon removing a neurofibroma from the femoral nerve of a patient.
6. A hand surgeon excising a neurolemmoma from the median nerve of a patient’s hand.
7. A vascular surgeon performing the excision of a neurofibroma from the popliteal nerve of a patient.
8. A podiatrist removing a neurolemmoma from the tibial nerve of a patient’s foot.
9. A maxillofacial surgeon excising a neurofibroma from the trigeminal nerve of a patient.
10. A thoracic surgeon performing the excision of a neurolemmoma from the phrenic nerve of a patient.