Wiki Injection of Incision Neuroma

[NESmith]

Please assist me in coding this. Procedure: Injection of Incision Neuroma
Identification of the appropriate affected incision was noted and skin markings were placed. Area was prepped and draped in a sterile fashion with betadine on 3 separate occasions. Sterile towels were place. A 25 ga needle was placed just adjacent to the affected incision. Needle was advanced until placement as close as possible to the preoperative affected region as per vocalization by patient. The needle was gently remanipulated until maximum sensory input was noted. 5 cc's of 0.5% bupivacaine was injected through the needle. The needle was then removed and the procedure was repated in the exact same dimensions on the incision in the region. Needles were removed and area was cleansed with a warm moist towel. Antibiotic ointment was placed and sterile bandages were applied.
Please help me. I have looked at so many codes I have confused myself.
Thanks as always.

 

[dwaldman]

Below is from CPT Assistant Sept 2010
Question:The patient has postmastectomy pain in the scar tissue area and not in the muscle. An injection was performed into the scar tissue of the chest area using a mixture of triamcinolone topical, lidocaine with epinephrine, and bupivacaine hydrochloride with epinephrine. What CPT code should be reported for this procedure?

Answer:Injection of painful scar tissue is reported using CPT code 64999,Unlisted procedure, nervous system. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.

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In the past I was under impression to use 11900

11900
Injection, intralesional; up to and including 7 lesions
The physician uses a syringe to inject a pharmacologic agent underneath or into seven or fewer skin lesions in 11900 and more than seven lesions in 11901. The lesions may be any healed skin lesions including post-laceration and post-surgical scar bands. The physician may inject steroids or anesthetics (not pre-operative local anesthetic) into these lesions.

Then I saw the above CPT Assistant and was confused what code to use for a scar/incision neuroma injection. Would it fall under painful scar tissue and use 64999? I don't think it would be inappropriate to use an unlisted code for the procedure you are describing.

 

[dwaldman]

AMA CPT Assistant

November 2013 page 14

Frequently Asked Questions:Surgery: Nervous System

Question: Is code 11900, Injection, intralesional; up to and including 7 lesions, or the unlisted code 64999 the appropriate code to report for injections of neuromas?

Answer: Neither code is appropriate to report for injections of neuromas. A "neuroma" is a thickening of scar tissue on the nerve and/or lining of the nerve; therefore, the appropriate nerve injection code should be reported based on the nerve injected. For example, code 64455, Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma), and code 64632, Destruction by neurolytic agent; plantar common digital nerve, would be reported for a neuroma injection involving the plantar nerves in the foot.