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injection coding - neuroma treatment

  1. #1
    Springfield, Mo
    Default injection coding - neuroma treatment
    Medical Coding Books
    Can someone tell me... is 20550 an appropriate code for an injection for neuroma treatment? The dx code the doctor used is 355.6 (lesion of plantar nerve) and his description of the injection says "into the 2nd intermetatarsal space". Does the description for 20550 apply to that (injection; single tendon sheath or ligament, aponeurosis)?

  2. Default
    A Morton's neuroma is a swollen, inflamed nerve located between the bones at the ball of the foot (usually either the second or the third spacing from the base of the great toe), which is 355.6.

    So, I would use code:

    64455 (Injection, anesthetic agent and/or steroid, plantar common digital nerve [eg. Morton's neuroma]).

  3. #3
    Springfield, Mo
    I am confused about the info on the WPS website. It says that 20550 is incorrect for
    355.6, and at the same time, 20550 is payable for 355.6. I don't know what to tell my doctors.
    solocoder CPC

  4. Default
    I would most definitely go with code (64455) because your physicians description matches the definition of Morton's neuroma and if you refer to the note under code 20550, the note instructs you to use 64455(nerve block) or 64632(destruction) depending on the physicians documentation.

  5. #5
    TonyaMichelle is correct on this one- we also use the same guidelines from wellmark and it says this:

    The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

    64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma)
    64632 Destruction by neurolytic agent; plantar common digital nerve

    ICD-9 Diagnosis
    355.6 Lesion of plantar nerve (Morton's metatarsalgia, neuralgia, or neuroma)

    If it were me having to explain this to my physicians, I would print off the guidelines and share it with them.

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  6. #6
    Springfield, Mo
    Default Need more advice, please.
    Thanks for the helpful replies. I showed my doctor the guidelines, BUT... he said yes, that applies to MCR but not to private payers? Is that correct?

  7. #7
    Columbia, MO
    No the definitions for the codes are for the use of the codes no matter who you are billing. You can get a coders Desk reference for procedures and this will help as well.

    Debra A. Mitchell, MSPH, CPC-H

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