Can CPT Code 64772 Be Billed Twice?

Current Procedural Terminology (CPT) codes are a standardized set of medical codes that describe medical, surgical, and diagnostic services. These codes are essential for healthcare providers to accurately bill for services rendered, allowing for consistent communication between providers, payers, and regulatory bodies. They form the foundation of medical billing, ensuring that procedures are correctly identified and processed for reimbursement.

Understanding the Scope of CPT Code 64772

CPT code 64772 specifically refers to the excision of a neuroma from a digital nerve in one interspace of the foot. A neuroma is essentially a thickening or benign growth of nerve tissue, often resulting from irritation, trauma, or compression of the nerve. In the context of the foot, digital nerves are sensory nerves that provide feeling to the toes and the spaces between them. These nerves can be found on both the top (dorsal) and bottom (plantar) aspects of the foot.

The term “one interspace” is crucial to understanding this code. Interspaces refer to the areas between the toes, specifically between the metatarsal bones of the forefoot. There are typically four interspaces in each foot, numbered from the big toe side to the little toe side. Morton’s neuroma, a common type of digital neuroma, most frequently occurs in the third interspace (between the third and fourth toes), and less commonly in the second interspace (between the second and third toes).

Billing for Bilateral Procedures

When the procedure described by CPT code 64772 is performed on both the left and right feet during the same operative session, it is considered a bilateral procedure. Each foot represents a distinct anatomical site, allowing for separate reporting of the service. To indicate that the procedure was performed bilaterally, Modifier 50 (Bilateral Procedure) is appended to the CPT code.

When using Modifier 50, the procedure code is typically reported on a single line item with one unit of service. For example, a claim for bilateral excision of neuromas using 64772 would often be submitted as “64772-50” with one unit. Reimbursement for bilateral procedures using Modifier 50 typically involves a percentage adjustment, often 150% of the fee schedule amount for the single procedure, though this can vary by payer.

Billing for Multiple Procedures on the Same Foot

A patient may present with neuromas in different interspaces within the same foot, necessitating multiple distinct excisions. For instance, a patient might have a neuroma in the second interspace and another in the third interspace of the right foot. Since CPT code 64772 is defined as addressing “one interspace,” each excision from a different interspace on the same foot constitutes a separate and distinct procedural service. To accurately report these multiple procedures on the same foot, modifiers are used to indicate their distinct nature.

Modifier 59 (Distinct Procedural Service) is commonly used to identify procedures that are not normally reported together but are appropriate under specific circumstances, such as being performed on different anatomical sites. For example, if two neuromas are excised from different interspaces on the same foot, the primary procedure would be reported as 64772, and the second procedure would be reported as 64772-59.

The Centers for Medicare & Medicaid Services (CMS) also introduced more specific X-modifiers (XE, XP, XS, XU) which can sometimes be used instead of Modifier 59 to provide greater reporting specificity. For procedures on different anatomical sites or structures, Modifier XS (Separate Structure) would be applicable. Therefore, for multiple neuromas on different interspaces of the same foot, 64772 could be reported for the first neuroma, and 64772-XS for the second, indicating a separate structure. It is important to note that Modifier 59 should only be used if no other more specific modifier is appropriate.

Essential Documentation for Multiple Claims

Accurate medical record documentation is crucial when billing CPT code 64772 multiple times, whether for bilateral procedures or multiple sites on the same foot. Insufficient documentation is a primary cause of claim denials and can lead to recoupment requests. Each procedure must have clear supporting details in the operative report or clinical notes.

Documentation should explicitly identify the laterality (left or right foot) for each procedure. For procedures on the same foot, the specific interspace for each excised neuroma must be clearly stated, such as “excision of neuroma from the third interspace, right foot” and “excision of neuroma from the second interspace, right foot.” A detailed description of each separate excision, including the approach and any unique challenges, is also necessary. Medical necessity for each individual procedure must be evident, explaining why each neuroma required surgical intervention. This documentation substantiates the distinct nature of the services and supports modifier use for reimbursement.