Podiatry Coding & Billing Alert

Question: The podiatrist diagnosed the patient with Morton’s neuroma. According to the podiatrist’s treatment plan, he injected a steroid or anesthetic agent for temporary pain relief. I believe we should report 64455 for this service, but one of my co-workers insists we report 64632. Could you please settle this debate?

Hawaii Subscriber

Answer: You are correct. For the service you described, you should report 64455 (Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma).

64455: When your podiatrist treats a neuroma through injections, you should report 64455. Code 64455 provides temporary relief of Morton’s neuroma. The podiatrist gives this injection in the plantar common digital nerve from the dorsal direction. The podiatrist injects a corticosteroid with an anesthetic around the nerve, which relieves the pressure on the nerve.

On the other hand, if, according to the documentation, the podiatrist took the patient’s treatment to the next level and administered an injection to destroy the nerve via a chemical, thermal, electrical or radiofrequency technique, then you would report 64632 (Destruction by neurolytic agent; plantar common digital nerve) instead of 64455.

64632: You should report 64632 if the podiatrist uses this procedure through chemical, thermal, electrical, or radiofrequency techniques. “When conservative treatment (eg, alteration of footwear, use of metatarsal pads, foot orthotic devices, steroid injection(s) (code 64455), and/or nonsteroidal anti-inflammatory medications) fails to provide relief of the symptoms, chemical destruction (neurolysis) of the plantar common digital nerve by injection is a treatment option,” according to CPT^® Assistant Vol. 19, No. 1.

Caution: You should not report 64455 (Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma) in conjunction with 64632 (Destruction by neurolytic agent; plantar common digital nerve), according to the CPT^® manual.

“Because the treatment therapies described by codes 64455 and 64632 are distinctly different, it would not be appropriate to report codes 64455 and 64632 for each of these therapies at the same session,” adds CPT^® Assistant Vol. 19, No. 1.