You Be the Coder:
Neuroma
Published on Wed Nov 01, 2000
Question: A patient presented to our office with a possible neuroma of the right lower limb. The patient had an amputation approximately six years ago. The physician injected the patient with 1cc lidocaine, 3mg celestone and 1cc bupivicaine 0.25 percent. The ICD-9 codes used were 729.5, 719.7, and 355.8. The patient was injected in the right stump. What CPT codes should I use?
Maryland Subscriber
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Answer: When using diagnosis codes, it is best to first choose the codes that justify the procedure. In this case, 355.8 (mononeuritis of lower limb, unspecified) justifies the procedure best and should be the first code. Limb pain (729.5) is less specific but could also be used to justify a peripheral nerve block. However, if this is phantom limb pain, 353.6 (phantom limb [syndrome]) might be a better code. Difficulty in walking (719.7) should be the third code because it is nonspecific and does not support the use of a nerve block as well as the other two do.
Your question does not state which nerve is blocked or whether the amputation was above or below the knee. The only leg nerve that has its own procedure code is the sciatic nerve (64445*, injection, anesthetic agent; sciatic nerve); all the other nerves of the leg or foreleg are coded with 64450* (injection, anesthetic agent; other peripheral nerve or branch) when injected with local and/or steroids. Because these are starred procedures, any type of preoperative exam and assessment the physician performed is also billable. Starred procedures are not global, and appropriate evaluation and management coding for the consultation or visit is warranted.
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