Pinpoint How to Code Neuroma Removal Procedures
Find out the difference between regular and Morton’s neuromas. Per the American Podiatric Medical Association, a neuroma is a “benign growth of nerve tissue frequently found between the third and fourth toes. It brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.” While it is unknown how neuromas form, experts believe foot shape, trauma, type of shoes, and recurrent stress can play key factors in their development. As a podiatry coder, your job is to identify neuroma treatment procedures and diagnoses in the documentation to accurately code the encounter. Continue reading to learn how to code neuroma procedures and diagnoses. Decode Neuroma Terminology The most frequent terminology associated with neuromas of the foot is Morton’s neuroma. Per the Cleveland Clinic, “Some healthcare providers refer to Morton’s neuromas as intermetatarsal neuromas or interdigital neuromas.” The Mayo Clinic echoes this statement by indicating “Morton’s neuroma also is called interdigital neuroma,” and explains that “nerves between other metatarsal bones also may be affected.” According to CPT® Assistant, Volume 19, Issue 1, “Plantar interdigital neuroma of the foot, often called ‘Morton’s neuroma’ [is] a common cause of forefoot pain and paresthesia. … The most common affected site is the third and fourth toe interspace, but it may also occur at the second toe interspace.” This is important to understand as general research regarding neuromas may point toward different terminology for neuromas located between different interspaces, with Morton’s neuroma typically referring to the third and fourth toe interspace (helpful hint: think of the big toe as the first and the pinkie toe as the fifth); however, it would appear that medical professionals and CPT® utilize the term Morton’s neuroma for interspaces beyond the third and fourth toe. While neuromas can also occur elsewhere in the foot, interdigital neuromas are by far the most common type that podiatry coders see. Understand the CPT® Code Options Various treatment options are available for neuromas, ranging from conservative treatment, which is aimed toward relieving pressure, to surgical correction when noninvasive options have failed. Conservative treatment can include ice, appropriate shoes, orthotics, padding and taping, medication, and injections. When conservative treatments fail, podiatrists will turn to surgical options. The CPT® code book contains several codes for the removal of neuromas. The codes are mainly distinguished by the location of the impacted nerve. For the excision of neuromas of the digital nerves, consider the following codes: You’ll report add-on code +64778 when an additional neuroma is excised from a subsequent digit. You must report the add-on code with primary code 64776. If the excised neuroma is in the foot, but is not located in the digits or interdigital space, these CPT® codes may be more appropriate: These codes are similar in structure to the digital nerve codes above. You’ll report add-on code +64783 for additional neuromas excised from elsewhere in the foot. You must report the add-on code with primary code 64782. Be aware: The CPT® range-specific guidelines for 64776, +64778, 64782, and +64783 indicate, “For Morton neurectomy, use 28080 [Excision, interdigital (Morton) neuroma, single, each].” As Morton’s neuromas are the most common type of neuroma in the foot, this is the main code utilized for neuroma removal in podiatry. You can report a unit of this code for each neuroma excised on the service date, generally up to 3 units. Code 28080 has a practitioner services Medically Unlikely Edit (MUE) of “3.” The MUE specifies the number of units that can be reported by the same provider, for the same patient, on the same date of service. The MUE Adjudication Indicator (MAI) for 28080 is also “3.” An MAI of “3” means the MUE is a date of service edit (clinical). As per Medicare MLN Matters Number MM8853, “These are ‘per day edits based on clinical benchmarks.’ If claim denials based on these edits are appealed, MACs may pay [units of service (UOS)] in excess of the MUE value if there is adequate documentation of medical necessity of correctly reported units.” For more information on MUE, MAI, and how to correctly report bilateral procedures, visit the Medicare NCCI [National Correct Coding Initiative] FAQ Library. If your provider decides to treat a Morton’s neuroma with an injection instead of a removal, you’ll consider these two additional CPT® codes: The parenthetical notes associated with these codes indicate you should not report them together, specifically when performed on the same nerve at the same encounter. According to CPT® Assistant, Volume 23, Issue 1, you can report 64455 only once per foot regardless of how many injections occur. This is because the descriptor contains the plural forms of “injection” and “nerve.” The article continues to instruct that 64632 “is used when a neurolytic agent is injected for the purpose of destroying the nerve. A neurolytic agent is used because of its affinity for nerve tissue and its expected potent neurotoxic effect. Code 64632 is reported for each plantar common digital nerve treated.” Consider the following modifiers when assigning these codes: Other modifiers may apply, but those listed above are often utilized with the CPT® codes. Review the Diagnosis Codes There are different sub terms in the ICD-10-CM Alphabetic Index that will lead to the correct diagnosis codes for neuromas. Start with looking up “Neuroma.” From here, “digital (toe),” “Morton’s,” and “plantar” will all lead to G57.6- (Lesion of plantar nerve). You’ll need a 5th character to identify the side of the body where the lesion is occurring, such as one of the following codes: The terms “interdigital, lower limb (toe)” and “intermetatarsal” both lead to G57.8- (Other specified mononeuropathies of lower limb). Use these codes for intermetatarsal neuroma of the foot other than Morton’s neuroma. They may also be appropriate for neuromas located elsewhere in the foot depending on the specific nerve involved. The provider’s documentation will be key to assigning the correct diagnosis code, such as: If documentation lacks appropriate specificity, one of the following may be the most accurate diagnosis code: Other diagnosis codes may be applicable depending on the specific scenario. As Morton’s neuroma is most often seen in podiatry coding, the correct diagnosis code will typically be from G57.60-G57.63. Always verify your local Medicare Administrative Contractor (MAC) and commercial payer policies for any relevant coverage criteria related to neuroma procedures. Leah Fuller, CHC, COC, CPC, Managing Consultant, Professional Audit and Consulting,
Pinnacle Enterprise Risk Consulting Services
