Podiatry Coding & Billing Alert

Hint: You should not report 64455 in conjunction with 64632.

When it comes to Morton’s neuroma, you will want to keep several CPT® and ICD-10 codes in your coding arsenal to make sure you always submit clean claims. But this can be tricky when there are specific guidelines you must remember — like which CPT® codes you should never report together and the ICD-10 codes that will support medical necessity.

Read on to learn how to report the correct Morton’s neuroma codes every time.

Myth 1: Morton’s Neuroma is Rare Kind of Neuroma

Truth:  Morton’s neuroma is actually the most common type of neuroma.

Morton’s neuroma is defined as a sustained irritation or inflammation that causes perineural fibrosis and thickening of the communicating branch between the medial and lateral plantar nerves in the third interspace between the third and fourth metatarsals, according to Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina.

Myth 2: You Can Report 64455 With 64632

Truth: You should not report 64455 (Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma) in conjunction with 64632 (Destruction by neurolytic agent; plantar common digital nerve), 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 Vol. 19, No. 1.

64455: When your podiatrist treats a neuroma through injections, you should report 64455. Code 64455 provides temporary relief of Morton’s neuroma. The podiatrist gives this injection in the plantar common digital nerve from the dorsal direction. The podiatrist injects a corticosteroid with an anesthetic around the nerve, which relieves the pressure on the nerve.

64632: Report 64632 if the podiatrist uses this procedure through chemical, thermal, electrical, or radiofrequency techniques. “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 example: The patient, a professional soccer player, has been experiencing tingling and burning into her toes, towards the middle part of her right foot. The podiatrist diagnoses the patient with Morton’s neuroma (G57.61,  Lesion of plantar nerve, right lower limb).

According to the podiatrist’s treatment plan, he injects a steroid or anesthetic agent for temporary pain relief. So, in this case, you would report 64455.

On the other hand, if, according to the documentation, the podiatrist took the patient’s treatment to the next level and administered an injection to destroy the nerve via a chemical, thermal, electrical or radiofrequency technique, then you should report 64632 instead of 64455.

Myth 3: For Neuroma Excision, You Can Report 64782

Truth: Code 64782 (Excision of neuroma; hand or foot, except digital nerve) is not considered appropriate for a Morton’s neuroma excision, said Dawn R. Cloud CPC, CMSCS, CHCI, CPOM, business owner of First Choice Billing, LLC, in Maricopa, Arizona, in a recent McVey Podiatry Seminar.

Instead, for a Morton’s neuroma excision, you would report 28080 (Excision, interdigital (Morton) neuroma, single, each), Cloud adds.

Don’t miss: This is where highlighting notes in your CPT^® manual can come in handy. In parenthesis under the subhead “Somatic Nerves,” you will see the note: (For Morton neurectomy, use 28080).

Myth 4: Supporting Diagnosis Codes Not Important When Showing Medical Necessity

Truth: As with anytime you report CPT^® codes, you must also report the appropriate corresponding ICD-10 codes that support the medical necessity for the service.

Examples: The MAC Noridian’s local coverage determination (LCD) — L34076 “Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton’s Neuroma,” identifies the ICD-10 codes that support medical necessity for these services.

Under the Group 1 Codes, the policy has a list of codes and it explains. “These are the only covered ICD-10-CM codes that support medical necessity.”

When it comes to the codes you will need to know for podiatry, these are the ones you will find on Noridian’s list:

• 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).

Myth 5: You Don’t Need to Pay Attention to Injection Frequency

Truth: Although different payers’ policies may differ on their clarification of how often podiatrists should perform neuroma injections, it is clear that you should always keep tabs on the frequency of these services.

First Coast: For example, according to First Coast’s policy, “Per episode of care, it is generally expected that one site per session is treated. For the rare situation when a neuroma is found in more than one interdigital space or found bilaterally, the treatment of more than one site per session during an episode of care will be allowed.”

“One additional injection/thermal treatment per episode of care is allowed if the neurolysis is incomplete and clinical symptoms persist after the initial injection/ thermal treatment,” the policy continues. Additionally, the LCD defines an episode of care as six months.