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Right Lower Extremity Stump Neuroma

  1. #1
    Default Right Lower Extremity Stump Neuroma
    Medical Coding Books
    Once again, please help. Procedure: Right lower extremity neuroma injection with insulated needle and nerve stimulation/
    With the patient having had an IV started ans all routine monitoring intact to include noninvasive blood pressure cuff and continuous pulse oximetry; the patient was placed in a prone position. The painful region was identified in the right popliteal fossa with visual palpation. We then anesthetized the superficial skin with 1% lidocaine local anesthesia. Through the anestheized skin we placed a radiofrequency needle with a 10 mm active tip. It was advanced with use of sensory simulation. Sensory stimulation reproduced the patient's pain originally at a tubal setting. The average was decreased with stimulation obtained at 0.2 V. After obtaining the stimulation we then prepared a solution containing 1-1/2 cc of Celestone Soluspan 10 mg and 6 cc of 0.25% bupivacaine. After negative aspiration the solution was injected incrementally. The needle was then removed and the are was sterilely cleaned and bandaged. the patient had a preoperative pain level of 7/10 and a postoperative pain level of zero. the patient was discharged with no apparent complications and will followup accordingly.
    Please advise what CPT code you would use. Thanks for your help

  2. #2
    Please cam anyone help me with this? Thanks

  3. #3
    It sounded like an effective procedure but it seemed like 64450 (popiteal region) was less work RVU then what was carried out. The stimulation would be inclusive to the procedure. I noticed it said the injection was done incrementally but did not notice a catheter being used. I believe it would be 64450 but held off on responding because I was not sure if I was missing something.

  4. #4
    I was responding with 64450 in mind for the neuroma the same as neuroma injection can be reported with a nerve block code:
    Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma)

    Three is also the CPT Assistant reference for painful scar tissue as 64999.

  5. #5
    Thank You as always dwaldman, but you were right there was no mention of a catheter being used. I am like you I was leaning towards 64450 but was not for sure if I was missing something too. As awlays you have provided great information.

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