coding excision and ED of multiple Neurofibromas

Help! I am at a loss. My Doc (Dermatologist) performed an excision of a neurofibroma, lesion + margins is 1.7 X 1.6cm. She also performed an ED of 6 adjacent NF. We originally billed the claim as 11442 and 17110. However, according to our Medicare LCD (We're in Alabama) neither 237.XX or 215.XX are acceptable diagnoses for the procedures! I have spent an hour scouring the internet on advice as to how to code this but I am coming up with nothing. I am wondering if we are using the wrong codes? Any help is much appreciated!!!

re: coding excision and ED of multiple Neurofibromas

237.xx wouldn't likely be the correct diagnosis, but I would need more information. What did the pathology results say?

An excision of a neurofibroma is coded as 64788 or 64790 or 64792 but this is only a suggestion; this could be wrong based  on what is documented in the procedure note.

I'm not familiar with the term "ED" - can you please clarify what this is? ...

237.xx wouldn't likely be the correct diagnosis, but I would need more information. What did the pathology results say?

An excision of a neurofibroma is coded as 64788 or 64790 or 64792 but this is only a suggestion; this could be wrong based on what is documented in the procedure note.

I'm not familiar with the term "ED" - can you please clarify what this is?

re: coding excision and ED of multiple Neurofibromas

Pathology reads "A dermal mass with fairly circumscribed margins and both the cytologic and architecttural features of schwannian differentiation is present. An S-100 immunostain strongly highlights the lesional cells confirming a neural origin. A CD31 immunostain highlights scattered small vessels but fails to highlight the lesional cells themselves." Under Diagnosis summary it just reads "A- Center of forehead - Neurofibroma".

Under the alphabetic index of my ICD-9 book when I look up neurofibroma it says "see also, Neoplasm, connective tissue, benign" and multiple neurofibroma points to 237.70. This was excised from the forehead, so neoplasm, connective tissue, benign, forehead is 215.0.

ED stands for electrodessication. My bad! I get caught up in abbreviations sometimes. Thanks so much for your help!!!

re: coding excision and ED of multiple Neurofibromas

I would say the CPT® for the forehead excision is 64788 Excision of neurofibroma or neurolemmoma; cutaneous nerve linked to ICD 215.0 - however, the procedure note would have to support this coding.

I'm not familiar with electrodessication (17110) and don't know if it would be considered inclusive to the 64788.

re: coding excision and ED of multiple Neurofibromas

So a dermatologist can preform this excision ?