# Neuroma Injection of BKA



## Melissa Harris CPC (Aug 17, 2016)

Hello,

Can someone help me with this procedure note?

NDICATIONS: Left lower extremity pain

DESCRIPTION OF PROCEDURE:  Per patient request, the patient was then administered 4 mL of 2 mg/2 mL midazolam IM by the nurse. The patient was placed seated on the procedure room table. Appropriate monitors were placed.  The lateral aspect of the left BKA stump was prepped with Betadine and draped in sterile fashion. The point of maximal tenderness was identified with palpation just below the level of the fibular head.  The area was then injected with a mixture of 2cc of 0.25% Marcaine mixed with 1mL of 40 mg/mL Kenalog. The injection was performed with a 25 gauge 1.5 inch needle. The needle was removed, the puncture wound was dressed, and he was removed to the recovery area in stable condition.

I was thinking 64450 or 64999?

Thank you
Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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## dwaldman (Aug 17, 2016)

AMA CPT Assistant November 2013 Surgery: Nervous System 

Question: Is code 11900, Injection, intralesional; up to and including 7 lesions, or the unlisted code 64999 the appropriate code to report for injections of neuromas?

Answer: Neither code is appropriate to report for injections of neuromas. A “neuroma” is a thickening of scar tissue on the nerve and/or lining of the nerve; therefore, the appropriate nerve injection code should be reported based on the nerve injected. For example, code 64455, Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma), and code 64632, Destruction by neurolytic agent; plantar common digital nerve, would be reported for a neuroma injection involving the plantar nerves in the foot. 

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From the guidance of CPT Assistant, the neuroma injection you are reporting could potentially fall under 64450.


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## Melissa Harris CPC (Aug 18, 2016)

Thank you so much.  That is the way I was thinking but just needed a second look from someone.   
Appreciate it!!


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## Urvishah (Mar 27, 2019)

*it's BKA*



dwaldman said:


> AMA CPT Assistant November 2013 Surgery: Nervous System
> 
> Question: Is code 11900, Injection, intralesional; up to and including 7 lesions, or the unlisted code 64999 the appropriate code to report for injections of neuromas?
> 
> ...



It's BKA - so, patient does not have foot, how can we code 64455 and 64632? Please suggest specific code. I have got same situation and looking for correct code.


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## LisaAlonso23 (Apr 29, 2019)

It looks like that would be 64450.


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