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The procedure described by CPT® Code 64778 pertains to the excision of a neuroma affecting the digital nerve in each additional digit. Neuromas are benign growths that can develop on the digital nerves, which are responsible for providing sensation to the fingers and toes. In the hand, the median nerve branches into lateral and medial components, which further divide into digital nerves that innervate the fingers. Similarly, in the foot, the medial and lateral plantar nerves branch out to form digital nerves for the toes. When these nerves become damaged or irritated, they can form neuromas, leading to pain and discomfort. The excision procedure involves making a skin incision over the neuroma, carefully exposing and dissecting the neuroma from the surrounding tissue, and then removing it. After the excision, the incision is closed. It is important to note that this code is specifically used in conjunction with a primary procedure code, such as CPT® Code 64776, which is used for the excision of a neuroma from one or both digital nerves in the same finger or toe. CPT® Code 64778 is designated for each additional digit where a neuroma excision is performed.
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The excision of a neuroma of the digital nerve is indicated for patients experiencing pain or discomfort due to the presence of a neuroma in the fingers or toes. This condition may manifest as localized pain, tenderness, or a burning sensation in the affected digit, often exacerbated by pressure or movement. The procedure is typically considered when conservative treatments, such as pain management or physical therapy, have failed to provide relief.
The procedure for excising a neuroma of the digital nerve involves several key steps that ensure the effective removal of the neuroma while minimizing damage to surrounding tissues. First, the patient is positioned comfortably, and the affected area is prepared and draped in a sterile manner. A local anesthetic is administered to numb the area around the neuroma, ensuring the patient remains comfortable throughout the procedure. Next, a skin incision is made directly over the site of the neuroma. The surgeon carefully dissects the tissue to expose the neuroma, taking care to avoid damaging the surrounding nerves and blood vessels. Once the neuroma is fully exposed, it is dissected free from the surrounding tissue and excised. After the neuroma is removed, the surgeon inspects the area to ensure that all of the neuroma has been successfully excised. Finally, the incision is closed using sutures or staples, and a sterile dressing is applied to protect the surgical site.
After the excision of a neuroma, patients are typically monitored for any immediate complications, such as excessive bleeding or infection. Post-procedure care includes instructions for wound care, which may involve keeping the incision clean and dry, changing dressings as needed, and watching for signs of infection. Patients may be advised to limit movement of the affected digit to promote healing and reduce discomfort. Pain management may be necessary, and the physician may prescribe analgesics to help manage post-operative pain. Follow-up appointments are usually scheduled to assess the healing process and to remove sutures if applicable. Patients are encouraged to report any unusual symptoms, such as increased pain, swelling, or changes in sensation in the affected area.
| Short Descr | DIGIT NERVE SURGERY ADD-ON | Medium Descr | EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT | Long Descr | Excision of neuroma; digital nerve, each additional digit (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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) | 1 - Statutory 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | 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 an add-on code that must be used in conjunction with one of these primary codes.
| 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. | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | F6 | Right hand, second digit | F7 | Right hand, third 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) | T2 | Left foot, third digit | T7 | Right foot, third digit |
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| Pre-1990 | Added | Code added. |
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