Podiatry Coding & Billing Alert

Question: A patient, who experiences pain, numbness, and a burning feeling in her in her foot, presents with Morton's neuroma. The podiatrist administered a steroid injection for temporary relief. I'm not sure what CPT to report. Could you help?

New Mexico Subscriber

Answer: When your podiatrist treats a condition affecting plantar common digital nerves -- in this case, Morton's neuroma (355.6, Lesion of plantar nerve) -- you should use 64455 or64632. While 64455 is just your steroid injection for temporary relief of Morton's neuroma, 64632 represents a more invasive treatment option for chronic pain: the nerve root that produces the chronic pain is destroyed by chemical, thermal, electrical, or radiofrequency techniques while leaving sensation intact. Which of the two codes should you use? It depends on your podiatrist's treatment plan. In the scenario given, your podiatrist injects a steroid or anesthetic agent for pain relief, so you should report 64455. If she takes treatment to the next level, however, and administers an injection to destroy the nerve (sometimes called chemodenervation), you'll submit 64632 instead.

Careful: CPT Changes 2009 states that you only report 64455 one time per session, regardless of the number of injections your physician administers. CPT 64632's exception is when your podiatrist provides bilateral treatment, in which case you'll report the appropriate code twice in those cases and append modifiers LT (Left side) and RT (Right side).

Watch out for services you might want to include with 64455 or 64632. CCI Edits has included these codes in bundled pairs in 2009.