# Right Lower Extremity Stump Neuroma



## NESmith (Sep 15, 2011)

Once again, please help. Procedure: Right lower extremity neuroma injection with insulated needle and nerve stimulation/
With the patient having had an IV started ans all routine monitoring intact to include noninvasive blood pressure cuff and continuous pulse oximetry; the patient was placed in a prone position. The painful region was identified in the right popliteal fossa with visual palpation. We then anesthetized the superficial skin with 1% lidocaine local anesthesia. Through the anestheized skin we placed a radiofrequency needle with a 10 mm active tip. It was advanced with use of sensory simulation. Sensory stimulation reproduced the patient's pain originally at a tubal setting. The average was decreased with stimulation obtained at 0.2 V. After obtaining the stimulation we then prepared a solution containing 1-1/2 cc of Celestone Soluspan 10 mg and 6 cc of 0.25% bupivacaine. After negative aspiration the solution was injected incrementally. The needle was then removed and the are was sterilely cleaned and bandaged. the patient had a preoperative pain level of 7/10 and a postoperative pain level of zero. the patient was discharged with no apparent complications and will followup accordingly.
Please advise what CPT code you would use. Thanks for your help


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## NESmith (Sep 27, 2011)

Please cam anyone help me with this? Thanks


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## dwaldman (Sep 27, 2011)

It sounded like an effective procedure but it seemed like 64450 (popiteal region) was less work RVU then what was carried  out. The stimulation would be inclusive to the procedure. I noticed it said the injection was done incrementally but did not notice a catheter being used. I believe it would be 64450 but held off on responding because I was not sure if I was missing something.


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## dwaldman (Sep 27, 2011)

I was responding with 64450 in mind for the neuroma the same as neuroma injection can be reported with a nerve block code:
64455  
Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma)  

Three is also the CPT Assistant reference for painful scar tissue as 64999.


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## NESmith (Sep 28, 2011)

Thank You as always dwaldman, but you were right there was no mention of a catheter being used. I am like you I was leaning towards 64450 but was not for sure if I was missing something too. As awlays you have provided great information.


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