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01/08/2020 David Secord, DPM
Cost-Effective Option for Sclerosing Injections? (Brad Toll, DPM)
As Dr. Toll is using the term "sclerosing" and that he follows Dr. Dockery's method of using 4% dehydrated EtOH (which is not a high enough concentration to cause sclerosis), I was wondering what code he is using? I'll submit a response to that question from the late great Harry Goldsmith, DPM:
“Sclerosing is a term that implies a change to the tissue, in this case, nerve. It is not necessarily associated with destruction. Typically, your alcohol product package insert will note that 40% or greater alcohol solutions are destructive to peripheral nerves. If you are sclerosing a nerve using less than 40% alcohol solution, you are not destroying it, and you cannot use either CPT 64632 or CPT 64640. In all likelihood, because a number of doctors report improvement in symptoms ranging from little/no to complete resolution, the effect is therapeutic.
I would tell you that you would code that injection as CPT 64450 - peripheral nerve block, therapeutic - regardless of the nerve injected. Having said that, I would caution you to check with the particular payer to see if they have any written policies limiting your coding or directing you to "its preferred" code. If your alcohol solution is 40% or greater (you'd better be sure you've read the literature studies on those concentrations), then if you are injecting an intermetatarsal neuroma, you would code the injection as CPT 64632. A peripheral nerve elsewhere on the foot, CPT 64640. You would not bill CPT 64455 - injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g., Morton's neuroma) - because you are not injecting cortisone as your therapeutic agent.”
David Secord, DPM, Corpus Christi, TX
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