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Endoscopic Decompression of Intermetatarsal Neuroma

Cory Posted Thu 01st of September, 2016 18:36:16 PM
Patient underwent left third space endoscopic decompression of the intermetatarsal neuroma. Surgeon used code 64704. Other sites have shown this is correct code. ASC, however, used 29999 CPT code, which is an unlisted arthroscopic procedure code. Below is what was on another podiatry site. A decompression of intermetatarsal nerve is part of a neuroplasty procedure which involves "the decompression or freeing of intact [digital plantar] nerve from scar tissue, including external neurolysis and/or transposition." If that procedure is performed, either open or endoscopically (there is no specific technique requirement listed in CPT - just that all of the requirements of neuroplasty (above) are met), then CPT 64702 (neuroplasty; digital,one or both, same digit) or CPT 64704 (neuroplasty; nerve of foot) -depending on the level of neuroplasty - would be the code of choice. If the "decompression" is performed percutaneously by incising the intermetatarsal ligament, it is not a neuroplasty. It is an incision of the intermetatarsal ligament. This should be coded as CPT 28899 (unlisted foot/toe procedure) since there is no CPT code for a procedure that only involves the incision of the intermetatarsal ligament. Be sure to include the op report and a letter of explanation along with the claim submission. Can't find anywhere that shows 29999 used in this instance. Any advice on correct coding? Thanks.
SuperCoder Answered Fri 02nd of September, 2016 05:51:43 AM

Greetings from SuperCoder!

Since there is no CPT code for endoscopic decompression of the intermetatarsal neuroma, you should report unlisted code 29999 (Unlisted procedure, arthroscopy)

An intermetatarsal neuroma of the foot is also referred to as a Morton's neuroma. A Morton's neuroma typically occurs between the third and fourth toes in the third interspace.

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