Podiatrists have a few different options for treating Morton’s neuroma, a painful condition affecting the ball of the foot. Because different services are possible, coders need to understand the various options and how to report them correctly to bring in accurate payment.
Here you’ll get a crash course in the resources you can use to ensure you follow CPT®, ICD-10-CM, and payer rules on reporting Morton’s neuroma and the services used to treat it. With solid, reliable information as your guide, you’ll be confident you’re submitting clean claims.
Follow AMA CPT® Guidance to Report Procedure Correctly
To choose the correct CPT® code for a procedure to treat Morton’s neuroma, you’ll need a dependable podiatry coding tool that includes official AMA CPT® code descriptors and guidelines. Below is more information on the codes you’ll typically apply.
Injection: For injection procedures, be sure you understand the difference between 64455 (Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma)) and 64632 (Destruction by neurolytic agent; plantar common digital nerve).
A typical 64455 scenario may involve the podiatrist injecting a corticosteroid with an anesthetic to provide temporary relief of Morton’s neuroma. Code 64632 represents a more aggressive treatment to destroy the nerve.
Tip: Code-level notes with both 64455 and 64632 tell you not to report the two codes together.
Excision: For excision procedures, be sure you use 28080 (Excision, interdigital (Morton) neuroma, single, each). Some coders erroneously report 64782 (Excision of neuroma; hand or foot, except digital nerve). If you check the AMA CPT® range guidelines for 64782, you’ll see this note: “For Morton neurectomy, use 28080.”
Money matters: Check out the chart that shows the Medicare national rates for the CPT® codes mentioned. You can see that the fees vary significantly, which means that if you select the wrong code, you could either be leaving money on the table or setting yourself up to have to return money to the payer after the mistake is discovered. Getting the code right the first time will save you that stress and frustration.
Medicare National Rates, Q3 2018
|Facility fee||Non-facility fee|
Check ICD-10-CM Index to Ensure Accurate Diagnosis Coding
Selecting the correct ICD-10-CM code for Morton’s neuroma is simple, but only if you know that the codes below apply:
- 60 (Lesion of plantar nerve, unspecified lower limb)
- 61 (Lesion of plantar nerve, right lower limb)
- 62 (Lesion of plantar nerve, left lower limb)
- 63 (Lesion of plantar nerve, bilateral lower limbs).
You can confirm that these are the correct codes by checking the ICD-10-CM index entry for “Neuroma, Morton’s,” which points to G57.6-.
Documentation tip: The clinician should already be documenting which limb is involved. Make sure you (the coder) know where to find that information so you can report the most specific code for the case (right, left, or bilateral).
Mine LCDs for Information on Coverage and Frequency Rules
Another valuable source of information for podiatry services related to Morton’s neuroma is your Medicare contractor’s LCD, or local coverage determination. If your payer publishes a policy related to the service, you’ll want to read it carefully, so you understand any coverage rules and frequency limitations. Also check to see if there is a list showing the ICD-10-CM codes that support coverage for the service you’re providing. Those listing are valuable ICD-10-CM to CPT® podiatry crosswalks that let you know what to expect in terms of coverage.
Example: Reviewing LCD L34076 from Noridian Healthcare Solutions (accessed August 2018), reveals several useful pointers for coders reporting to that payer:
- You should not report 20550, 20551, 64450, or 64640 for Morton’s neuroma injections. Use only 64455 or 64632.
- More than three injections to the same neuroma in six months must be supported by documentation stating why more treatment is expected to work
- Dry needling is not covered.
- You should use G57.61, G57.62 or G57.63 for Morton’s metatarsalgia, neuralgia, or neuroma, in support of 64455 or 64632. Note that unspecified code G57.60 is not listed as covered.
Smart move: Ensure you’ve got access to up-to-date resources for podiatry CPT® lookup, ICD-10-CM search, and LCDs to keep your claims for Morton’s neuroma services accurate. And as one last tip, remember to consider the impact of other possible codes involved. You’ll want convenient access to HCPCS codes if you need to claim reimbursement for drugs injected, and you’ll need to check Correct Coding Initiative edits if you report multiple CPT® and HCPCS codes for the same date.