Orthopedic Coding Alert

Question: The article in the May 2003 Orthopedic Coding Alert about differentiating between trigger point and ligament injections left me with a related question: How should we report injections for lateral epicondylitis or Morton's neuroma? These don't really fit into the other injection categories.

New Jersey Subscriber

Answer: Orthopedists administer lateral epicondylitis (726.32) injections to the origin of the common extensor muscle on the lateral epicondyle. You therefore should report 20551 (Injection[s]; tendon origin/insertion) for these procedures.

Because Morton's neuroma (355.6) injections occur in the intermetatarsal space, insurers differ on which code most accurately describes the service. Empire Medicare, the Part B carrier for New Jersey, states, "In the treatment of Morton's neuroma, the injection is into the surrounding tissue and not the nerve complex. Therefore, CPT code 20550* (Injection[s]; tendon sheath, ligament) must be reported and NOT CPT code 64450* (Injection, anesthetic agent; other peripheral nerve or branch)."

Not all carriers agree with Empire's interpretation, however. CGBA's (the Part B carrier for Iowa and South Dakota) policy states, "Injection therapy for tarsal tunnel syndromes and for Morton's neuroma does not involve the structures described by CPT codes 20550 and 20551 or direct injection into the nerves involved, but rather injection of the surrounding tissues. These therapies are not specifically addressed by code 20550. Therefore, the provider of these therapies must bill with CPT code 28899 (Unlisted procedure, foot or toes)."

Because insurers'policies for Morton's neuroma injections vary so widely, you should always confirm your carrier's guidelines before administering these injections.