Podiatry Coding & Billing Alert

Question: My podiatrist performed a plantar nerve destruction to treat pain from Morton's neuroma in an outpatient hospital. The chart note indicates he used fluoroscopic guidance. How would I code this?

New Mexico Subscriber

Answer: If your podiatrist uses fluoroscopic guidance for either a nerve destruction or block, then add 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) to your claim.

Report 77002 only once per region, regardless of how many injections your physician administers.

Append modifier 26 (Professional component) if the podiatrist performs the procedure in a facility site of service, meaning place of service code 21 (Inpatient hospital), 22 (Outpatient hospital), or 24 (Ambulatory surgical center).

The modifier tells the payer that the podiatrist is billing only for doing the guidance, not for owning the equipment. The facility would bill the technical component with TC. In the office setting, you would use the global code claiming both the work and the equipment portions.

Watch for: To report 77002 compliantly, your physician should include documentation stating that he used fluoroscopic guidance for the procedure. According to American College of Radiology guidelines, the documentation should include details about the procedure and materials, findings, and your physician's impressions.

To round out your claim, you would also report 64632 (Destruction by neurolytic agent; plantar common digital nerve) for the nerve destruction and (355.6, Lesion of plantar nerve) for the diagnosis code.