Internal Medicine Coding Alert

Question: Our physician administers a lot of steroid injections and injections of anesthetic for patients having pain in the sole of their foot. How should I code these? Is there any critical information that I need to know when reporting these procedures?

North Carolina Subscriber

Answer: Use 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [e.g., Morton's neuroma]). You should also use the proper J code to indicate the type of steroid injected with 64455.

Physicians often administer steroid and anesthetic injections on the foot to treat Morton's neuroma, a frequently occurring injury of the forefoot that affects the third web space of the toes. During the procedure, the physician injects either an anesthetic agent or a steroid into the plantar common digital nerve from the dorsal direction.

Watch out: Make sure you do not list 64455 in conjunction with 64632 (Destruction by neurolytic agent; plantar common digital nerve), for the same foot. In 64632, the physician uses chemical (neurolytic substance such as alcohol, phenol, glycerol), thermal (heat), electrical (electric current), or radiofrequency techniques (solar or microwave current), independently or in combination, to destroy the nerve causing chronic pain.

Both 64455 and 64632 address pain in the plantar common digital nerve. Therefore, your physician would perform only one procedure for the ailment per foot at one time.