Podiatry Coding & Billing Alert

Question: A patient visited our podiatrist with a complaint of sharp burning pain in the third toe of the left foot, which increases while walking. Our physician diagnosed Morton’s neuroma and administered an injection for relief. How should I code the encounter?

Nebraska Subscriber

Answer: For the office visit, you should report any of the initial E/M visit codes (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:…) depending upon the time spent and complexity of the symptoms.

You have not mentioned whether the physician administered the injection for relief or destruction of the nerve. For a steroid injection, you can report code 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [eg, Morton’s neuroma]) with modifier LT (Left side). In such a procedure, the physician injects a corticosteroid (such as triamcinolone, depomedrol, or prednisone) or an anesthetic substance into the plantar common digital nerve for the treatment of Morton’s neuroma or other inflammatory nerve conditions.

The podiatrist may also decide to destroy the nerves that are responsible for carrying pain. For reporting a neurolytic injection, choose CPT^® code 64632 (Destruction by neurolytic agent; plantar common digital nerve) with modifier LT (Left side) to specify which foot the podiatrist treated.

Morton’s neuroma, named after Thomas G. Morton and Thomas K. Morton, is a result of compression of the common digital nerves of the toes, particularly, the third toe. While a neuroma is clinically a benign tumor, you won’t find Morton’s neuroma listed in the neoplasm codes. It is not an actual neurom a but an inflamed digital nerve in the foot. You can support the injection procedure for the Morton’s neuroma, with diagnosis code 355.6 (Lesion of plantar nerve). Under ICD-10, although 355.6 directly crosswalks to G57.60 (Lesion of plantar nerve, unspecified lower limb), you will be reporting the more specific code G57.62 (Lesion of plantar nerve, left lower limb).

With an injection, you must document the reason for the injection (therapeutic), the injection site (left foot), the substance that you inject (in this case, possibly celestone) and the amount injected.