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The procedure described by CPT® Code 64776 involves the excision of a neuroma affecting the digital nerve, which can occur in either one or both nerves of the same digit, whether it be a finger or a toe. Digital nerves are responsible for providing sensation to the fingers and toes, and they can become the site of painful benign growths known as neuromas. In the hand, the median nerve branches into lateral and medial components, which further divide into digital nerves that innervate the fingers. Specifically, the lateral digital nerve branches into three parts, with two serving the thumb and one serving the radial side of the index finger. The medial digital nerve also divides into common palmar digital nerves that innervate the remaining fingers. In the foot, the medial and lateral plantar nerves similarly branch out to form digital nerves for the toes, with each toe receiving two branches. When these nerves develop neuromas, they can cause significant discomfort, necessitating surgical intervention. The surgical procedure involves making a skin incision over the neuroma site, carefully exposing the neuroma, and then dissecting it free from the surrounding tissue before excising it. Finally, the incision is closed. This code specifically applies to the excision of a neuroma from one or both digital nerves in the same digit, while a different code, CPT® 64778, is used for excision of neuromas in additional fingers or toes.
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The excision of a neuroma of the digital nerve is indicated for patients experiencing significant pain or discomfort due to the presence of a neuroma in the fingers or toes. This procedure is typically considered when conservative treatments, such as medication or physical therapy, have failed to alleviate symptoms. The following conditions may warrant the excision of a neuroma:
The procedure for excising a neuroma of the digital nerve involves several key steps, which are outlined below:
Post-procedure care following the excision of a neuroma includes monitoring the surgical site for signs of infection, managing pain with prescribed medications, and following up with the healthcare provider as directed. Patients are typically advised to keep the incision clean and dry, and to avoid strenuous activities that may stress the surgical site during the initial healing period. Recovery time may vary depending on the individual and the extent of the procedure, but most patients can expect to resume normal activities within a few weeks, provided there are no complications.
| Short Descr | REMOVE DIGIT NERVE LESION | Medium Descr | EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT | Long Descr | Excision of neuroma; digital nerve, 1 or both, same digit | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
This is a primary code that can be used with these additional add-on codes.
| 64778 | Addon Code MPFS Status: Active Code APC N ASC N1 Illustration for Code Excision of neuroma; digital nerve, each additional digit (List separately in addition to code for primary procedure) | 64787 | Addon Code MPFS Status: Active Code APC N ASC N1 Illustration for Code Implantation of nerve end into bone or muscle (List separately in addition to neuroma excision) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | F1 | Left hand, second digit | F2 | Left hand, third digit | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | F5 | Right hand, thumb | F6 | Right hand, second digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | F9 | Right hand, fifth digit | FA | Left hand, thumb | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | T1 | Left foot, second digit | T2 | Left foot, third digit | T4 | Left foot, fifth digit | T5 | Right foot, great toe | T6 | Right foot, second digit | T7 | Right foot, third digit | T9 | Right foot, fifth digit | TA | Left foot, great toe | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2009-01-01 | Changed | Code description changed |
| Pre-1990 | Added | Code added. |
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