Anesthesia Coding Alert

Diagnosis of nerve and ligament disorders, such as neuromas and tarsal tunnel syndrome, begins with an examination. Rob Davey, CPC, coding consultant with Auditing for Compliance and Education Inc. (ACE) of Leawood, Kan., says, There are three elements that comprise an evaluation and management visit history of present illness, problem-focused examination, and medical decision-making. Yet, the documented medical decision-making by the physician is what ultimately determines the level of E/M code. For E/M of conditions like neuromas or tarsal tunnel syndrome, I would expect a level-three (99203) or -four (99204) initial visit code." Code 99203 includes a detailed history, a detailed examination, and medical decision-making of low complexity, while 99204 includes a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity. Corinne Kauderer, MD, DPM, FAAHP, FACFAOM, FACFAS, a podiatrist in Brooklyn, N.Y., usually uses 99203 for patient visits for neuromas and tarsal tunnel.
 
For Morton's neuroma and intermetatarsal neuroma (355.6, Lesion of plantar nerve; Morton's metatarsalgia, neuralgia, or neuroma), range-of-motion tests or x-rays may be required to rule out arthritis, joint inflammation, or stress factors. Heidi Stout, CPC, CCS-P, coding and reimbursement manager of University Orthopedic Associates in New Brunswick, N.J., says, "Needle electromyography and nerve conduction studies may be performed in diagnosing tarsal tunnel syndrome (355.5). "Some orthopedic practices have physiatrists or other specialists on staff who conduct this testing." CPT 2002 defines needle electromyography procedures with 95860-95872. Nerve conduction study codes are:
  CPT 95900 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study
CPT 95903 motor, with F-wave study
95904 sensory
CPT 95920 Intraoperative neurophysiology testing, per hour (list separately in addition to code for primary procedure).
CPT 2002 states that 95900, 95903 and 95904 are modifier -51 (Multiple procedures) exempt. These codes should be reported only once when multiple sites on the same nerve are stimulated or recorded.
 
Stout advises coders that the diagnosis must support the medical necessity of testing. Davey says, "It is important for coders and billers to review payer policies carefully. Claims are mainly denied because of an unspecified diagnosis or a diagnosis that is deemed nonmedically necessary. Specificity is crucial use the diagnosis code that best matches the symptoms."
Treating the Conditions
Conservative treatment for all of these conditions usually includes orthoses and physical therapy. For Morton's neuroma and tarsal tunnel syndrome, injection of an anesthetic agent, such as lidocaine, may bring some relief. Stout says that 64450* (Injection, anesthetic agent; other peripheral nerve or branch) is used most frequently in their practice. She also notes that Medicare does not reimburse for the anesthetic agent.