Neurosurgery Coding Alert

Question: The provider performed a steroid injection on a patient with a Morton's neuroma of the left foot. I initially reported code 64450, but received a denial. I am not sure if the denial is for the CPT^® code or the diagnosis code. The diagnosis code I applied is G57.62; how should I change the claim for resubmission?

Texas Subscriber

Answer: To begin, the issue here clearly arises from the use of the CPT^® code, not the diagnosis code. The G57.62 (Lesion of plantar nerve, left lower limb) code is the correct diagnosis for a Morton's neuroma of the left foot.

If the provider did not list the injection site, you will first want to confirm if the injection did occur in the left foot, specifically at the base of or in between the toes. As for the CPT^® code, after review you should determine that 64450 (Injection, anesthetic agent; other peripheral nerve or branch) is not the most accurate code available to code a steroid injection for a Morton's neuroma.

According to "Stedman's Medical Dictionary," a Morton's neuroma is "a painful, tender focal mass lesion on one of the plantar interdigital nerves of the foot, most often that which is situated between the third and fourth metatarsal bones." Since there is a more specific CPT^® code than reporting injection of "other peripheral nerve or branch," you can immediately rule out 64450 as a valid coding option.

Fortunately, there is a code that fits the description of a steroid injection for a Morton's neuroma perfectly. If you had searched for the CPT^® code following 64450, you would have found 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [eg, Morton's neuroma]), which fits the description perfectly.