# injection of neuroma



## beatet66 (May 6, 2013)

Hello, 
I am hoping to get some clarification/information regarding a procedure my provider is performing.
The op report is as follows:
Identification of the appropriate affected incision was noted and skin markings were placed. Area was prepped and draped in a sterile fashion with betadine on 3 separate
occasions. Sterile towels were placed. A terason ultrasound probe was prepared sterile and placed over the operative area, ultrasound imagery was performed and appropriate identification of the subcutaneous nerve associated with the previous surgical incision site was identified, appropriate adjacent vascular structures were also identified. A 25 ga needle was placed just adjacent to the affected incision. Needle was advanced until placement as close a possible to the preoperative affected region as per vocalization by patient. The needle was connected to a peripheral nerve stimulator and stimulation was performed at 0.5 mv with positive identification for her preoperative pain was reproduced. The needle was gently remanipulated until maximum sensory input was noted. 5 cc's of 0.5% bupivacaine was injected through the needle. The needle was then removed and the procedure was repeated in the exact same dimensions on the incision in the region.
I am not sure if this can be coded with CPT 64450, without actually specifying the       nerve(s) being targeted or if this should be coded with the unlisted CPT 64999?
Any help/guidance would be greatly appreciated.
Thank you!


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## mitchellde (May 6, 2013)

I would send the note back tot he provider for revision to include the location.


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## dwaldman (May 10, 2013)

For a neuroma injection, below is from this forum from the AMA CPT Network

https://www.aapc.com/memberarea/forums/showthread.php?t=16475

Inquiry Question:
What is the best code for a Scar Neuroma Injection?
11900?
64640?
64999?

Please be advised that your inquiry was forwarded to our CPT Advisor representing the American Academy of Pain Medicine for review. Based solely upon the information provided in your electronic inquiry, from a CPT coding perspective and per our CPT Advisor, ?It would be appropriate to report a nerve block injection code for the anatomic site involved or a destruction code if neurolysis is the goal. Most specifically, CPT codes 64450, Injection, anesthetic agent; other peripheral nerve or branch, or 64640, Destruction bby neurolytic agent; other peripheral nerve or branch, for this injection(s), since these codes respectively address the additional work of an injection of an anesthetic agent (nerve block), neurolytic or sclerosing agent into the peripheral nerves.


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