Podiatry Coding & Billing Alert

Understanding different intervention options is key to coding this condition.

It’s likely that your podiatrist encounters Morton’s neuroma cases in their practice. Morton’s neuroma, the most prevalent type of neuroma, is a benign but painful neuroma of an intermetatarsal plantar nerve, typically found in the third and fourth intermetatarsal spaces. To accurately document procedures related to this condition, it’s crucial to be familiar with the various treatment options along with how to code them.

Take note of these tips to consistently file flawless Morton’s neuroma claims in your practice.

Tip #1: Start With Non-Invasive Treatment Options

Your podiatrist will first try to use conservative options for the treatment of Morton’s neuroma.

These options can offer pain relief if performed in the early stages of Morton’s neuroma. While many patients choose to use these tools to avoid injections, the relief may only be temporary. Your podiatrist may recommend medication such as Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs) for pain, ice and/or physical therapy, as well as orthotics. According to Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, director of healthcare training and practice support at Healthcare Inspired LLC, in Bella Vista, Arkansas, “Conservative measures, including padding, orthotics, corticosteroid injections, physical therapy, and footwear modifications, offer relief for many with Morton’s neuroma, with success rates ranging from 50 to 80 percent.” If symptoms persist despite these efforts, surgery becomes a consideration. “While there’s no specific timeline for surgery, it’s recommended when conservative treatments are exhausted,” she adds.

Tip #2: Understand the Difference Between Codes for Treatment

If conservative treatment has been unsuccessful, your podiatrist may choose to administer pain relieving injections instead.

Coding example: The podiatrist treated Morton’s neuroma through an injection. They injected corticosteroid with an anesthetic around the nerve to relieve the pressure on the nerve. Which code should you report?

Solution: You should report 64455 (Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, Morton’s neuroma)).

Code 64455 provides temporary relief of Morton’s neuroma. The podiatrist gives this injection in the plantar common digital nerve from the dorsal direction. You should only report 64455 one time per session, regardless of the number of injections your podiatrist administers. The only exception to this rule is when your podiatrist provides bilateral treatment. You’ll report the appropriate code twice in those cases, appending modifiers LT (Left side) and RT (Right side). You should send notes with bilateral 64455 services, since payers consistently deny more than one unit per day, even when billed correctly on two lines with the modifiers.

On the other hand, “when conservative treatment (eg, alteration of footwear, use of metatarsal pads, foot orthotic devices, steroid injection(s) (code 64455), and/or nonsteroidal anti-inflammatory medications) all fail to provide relief to the patient, chemical destruction (neurolysis) of the plantar common digital nerve by injection is a treatment option,” according to CPT^® Assistant Vol. 19, No. 1. In this case, you should report code 64632 (Destruction by neurolytic agent; plantar common digital nerve) for a neurolytic injection.

Don’t miss: You should never report 64455 in conjunction with 64632. “Because the treatment therapies described by codes 64455 and 64632 are distinctly different, it would not be appropriate to report codes 64455 and 64632 for each of these therapies at the same session,” CPT^® Assistant adds.

Tip #3: How to Code for Surgery When Necessary

If pain treatment via therapy or injections is no longer a viable option, your podiatrist may opt to perform surgery. In such cases, the podiatrist creates an incision in the interspace where the neuroma is located, then carefully dissects through the subcutaneous tissue, ensuring the nerves and vessels are safeguarded before identifying and excising the neuroma. The wound is then cleansed with an antibiotic solution before being closed in layers.

In this case, you should report 28080 (Excision, interdigital (Morton) neuroma, single, each).

Don’t miss: You should report one unit of 28080 for each neuroma excision your podiatrist performs during the surgical session.

Tip #4: Don’t Confuse 28080 With These Codes

Before you reach for 28080, make sure you understand the difference between neuroma excision and two other, similar-sounding procedures: neurectomies and neuroplasties.

Because 28055 (Neurectomy, intrinsic musculature of foot), like 28080, falls within the “repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon” range of the CPT^® code set, you might be tempted to use it instead of 28080.

However, the two codes differ due to location. With 28055, the practitioner is working on the plantar nerves, not the metatarsal heads. During a neurectomy, the provider removes any inflamed bursal tissue and dissects the nerve, dividing it at the upper point to relieve pain. For example, the provider makes an incision in the dorsal skin between the intermetatarsal spaces from the metatarsal head through the end of the web space’s skin fold. The provider divides the transverse metatarsal ligament, spreads the metatarsal heads, and dissects and divides the nerve at the upper point. Finally, they irrigate the wound with antibiotic solution and close the wound in layers.