Podiatry Coding & Billing Alert

Question: When would 64455 be appropriate when treating nerve pain and when would 64632 be more appropriate? Can you delineate the difference between the two codes? Also, how many times can I report each per day for the same patient?

Wisconsin Subscriber

Answer: To determine the correct code, check your physician's treatment plan. If he injects a steroid or anesthetic agent for pain relief, report 64455. If he takes treatment to the next level, however, and administers an injection to destroy the nerve (sometimes called chemodenervation), you'll submit 64632 instead.

According to CPT Changes 2009: An Insider's View, you report 64455 only one time per session, regardless of the number of injections your physician administers; the same holds true for 64632.

Both 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [eg, Morton's neuroma]) and 64632 (Destruction by neurolytic agent; plantar common digital nerve) come into play when your podiatrist treats a condition affecting plantar common digital nerves. One of the most common scenarios would be when a patient presents with Morton's neuroma -- a thickening of the plantar nerve between the heads of the metatarsals (355.6, Lesion of plantar nerve). Symptoms usually include pain, tingling, burning, or numbness.

Playing sports or wearing shoes with a narrow toe box can cause Morton's neuroma.

Basically, 64455 is a steroid injection for temporary relief of Morton's neuroma. Code 64632, however, 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.

Exception: When your podiatrist provides bilateral treatment, you'll report both nerve destructions. Check your payer's guidelines on using modifier 50 (definition), units (2), or body side modifiers (RT, LT).

Keep in mind that 2010 Correct Coding Initiative (CCI) edits were quick to include 64455 and 64632 in bundled pairs earlier this year. Watch what services you might want to code in conjunction with 64455 or 64632 because they both include the work represented by:

• microsurgery code +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) and

• muscle and nerve test codes 95860-95861, 95867-95868, 95870, 95900, 95904, 95920, 95925-95930, 95933-95934, 95936-95937.

Because these edits carry a modifier indicator of "0," you cannot unbundle them and separately report the procedures for any reason.