Podiatry Coding & Billing Alert

Report 28080 for Morton’s neuroma excision.

Chances are that your podiatrist sees cases of Morton’s neuroma, the most common type of neuroma, in their practice. Morton’s neuroma is a benign neuroma of an intermetatarsal plantar nerve, usually of the third and fourth intermetatarsal spaces. To successfully report this condition, you need to know the appropriate CPT^® codes to report for the injections, as well as the proper excision code.

Follow these steps to always submit clean Morton’s neuroma claims in your practice.

Step 1: First, Focus on Conservative Care Options

Your podiatrist will first try conservative care for Morton’s neuroma.

There are several options for conservative care for Morton’s neuroma, explains Jeri L Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. These options can offer pain relief if done 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.

Step 2: Differentiate Between Codes 64632 and 64455

Your podiatrist may choose to administer an injection to treat the patient’s Morton’s neuroma. In this case, you have two code choices: 64455 (Injection[s], anesthetic agent[s] and/ or steroid, plantar common digital nerve[s] [eg, Morton’s neuroma]) or 64632 (Destruction by neurolytic agent; plantar common digital nerve).

Code 64455: If your podiatrist administers a steroid injection for temporary relief of the Morton’s neuroma, you should report code 64455 (Injection[s], anesthetic agent[s] and/ or steroid, plantar common digital nerve[s] [eg, Morton’s neuroma])). In this procedure, the podiatrist injects a corticosteroid (such as triamcinolone, depomedrol, or prednisone) with an anesthetic around the nerve, which relieves the pressure on the nerve.

Code 64632: On the other hand, your podiatrist may decide to destroy the nerves that are responsible for carrying pain. In this case, you should report code 64632 (Destruction by neurolytic agent; plantar common digital nerve) for a neurolytic injection. “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) fails to provide relief of the symptoms, chemical destruction (neurolysis) of the plantar common digital nerve by injection is a treatment option,” according to CPT^® Assistant Vol. 19, No. 1.

Coding note: You can only report 64632 one time per session, regardless of the number of injections your physician administers. The exception is when your podiatrist provides bilateral treatment. You’ll report the appropriate code twice in those cases and append the modifiers LT (Left side) and RT (Right side).

Don’t miss: You should never report 64455 in conjunction with 64632, according to the CPT^® manual.

“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,” adds CPT^® Assistant.

Step 3: Rely on This Code for Morton’s Neuroma Excision

Your podiatrist may choose to excise a Morton’s neuroma. 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.

Example: After prepping and anesthetizing the patient, your podiatrist makes an incision in the interspace where the neuroma exists. Your podiatrist dissects down through subcutaneous tissue, protecting the nerves and vessels. They identify and remove the neuroma. Finally, they irrigate the wound with antibiotic solution and close the wound in layers. You will report 28080 on your claim.

Step 4: Don’t Forget the Proper ICD-10-CM Code

Podiatrists can use a physical exam, X-rays, and diagnostic ultrasound (US) to diagnose a Morton’s neuroma. When your podiatrist diagnoses a patient with Morton’s neuroma, you have the following ICD-10-CM codes to choose from:

• G57.61 (Lesion of plantar nerve, right lower limb)
• G57.62 (Lesion of plantar nerve, left lower limb)
• G57.63 (Lesion of plantar nerve, bilateral lower limbs) Note: Insurance companies will not pay a claim if the bilateral code is attached to it, Jordan explains.