How to do billing for nerve blocks 64450, 64447

How to do Billing for Peripheral Nerve Blocks CPT 64450 Femoral Nerve Block 64447 Intercostal Nerve Block CPT 64420, CPT 64421

Why Nerve Blocks for Pain Management and what are they in terms of meeting the Medical Necessity?

• Femoral nerve blocks are mostly indicate for acute post-operative pain after knee replacement surgery or when patient has chronic pain in the area;
• Intercostal nerve blocks are indicated mostly for acute intercostal pain, and for chronic intercostal neuritis and is being considered as part of a comprehensive pain management program
• Peripheral nerve blocks are mostly indicated for the treatment of acute pain, and for chronic pain only as part of an active component of a comprehensive pain management program
• Acute pain, and for chronic pain only as part of an active component of a comprehensive pain management program
• Peripheral nerve blocks for the treatment of chronic pain​​

The Different kinds or types of NERVE BLOCKS and what are they targeting: 

NERVE BLOCKS: Brachial plexus block, elbow block, wrist block 
Targeted BODY AREAS: Shoulder, arm, hand, elbow, wrist) 

NERVE BLOCKS: Cervical epidural, thoracic epidural, lumbar epidural block 
Targeted BODY AREAS: Neck, back

NERVE BLOCKS: Cervical plexus block, cervical paravertebral block 
Targeted BODY AREAS: Shoulder, upper neck   

NERVE BLOCKS: Maxillary nerve block 
Targeted BODY AREAS: Upper jaw  

NERVE BLOCKS: Ophthalmic nerve block 
Targeted BODY AREAS: Eyelids, scalp   

NERVE BLOCKS: Sphenopalatine nerve block 
Targeted BODY AREAS: Nose, palate   

NERVE BLOCKS: Subarachnoid block, Celiac plexus block 
Targeted BODY AREAS: Abdomen, pelvis   

NERVE BLOCKS: Supraorbital nerve block 
Targeted BODY AREAS: Forehead   

NERVE BLOCKS: Trigeminal nerve block 
Targeted: BODY AREAS: Face

For Peripheral Nerve Blocks , use CPT Code 64450

CPT codes covered if selection criteria are met:
64400 - Introduction/Injection of anesthetic agent(nerve block), diagnostic or therapeutic [not covered as sole treatment of chronic pain, for cluneal, ganglion, genicular, and obturator nerve blocks for chronic pain or for repetitive peripheral nerve blocks for chronic non-hyphenmalignant pain]
Common ICD-10 Cross Over:
G89.11 - G89.18 Acute pain
G89.21 -G89.29 Chronic pain

Femoral Nerve Blocks, use CPT Code 64447, Intercosta Nerve Block, use CPT Code 64420, 64421

64447    Injection of anesthetic agent; femoral nerve, single
Common ICD-10 Cross Over:
M25.561 - M25.569 Pain in knee
Z96.651 - Z96.659 Presence of artificial knee joint
​
64425 Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves

Intercostal Nerve Blocks
64420 - 64421 Intercostal nerve blocks
Common ICD-10 Cross Over:
G54.8 Other nerve root and plexus disorders - intercostal neuritis

Infraclavicular-Suprascapular Nerve Blocks
64415 Injection, anesthetic agent; brachial plexus, single
64418 Suprascapular  Nerve Blocks
Common ICD-10 Cross Over:
M25.511 -M25.519 
M79.601-M79.603
M79.621-M79.646

Greater Occipital Nerve Blocks:
64405 Injection, anesthetic agent; greater occipital nerve
Common ICD-10 Cross Over:
M54.2 Cervicalgia
M54.81 Occipital neuralgia
M54.9 Dorsalgia, unspecified
M96.1 Postlaminectomy syndrome, not elsewhere classified 

Questions on the Lateral Branch BLOCKS. Got one? Let's discuss below.

Looking at the lateral branch nerve is a peripheral nerve and would be reported with CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch, when a lateral branch nerve block is performed.

Please note: CPT code 64450 should only be reported per nerve or branch and not per injection.

CPT code 76942, Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation, would be additionally reported when utilizing ultrasound guidance for certain nerve block procedures when it is not inherent in the primary procedure code.

Let's Review at the following Reader's Questions again:

Reader Question
"What are the appropriate code assignments when a patient receives 3 separate nerve blocks into the same lateral branch nerve? Would it be appropriate to report 3 units of this service?"
The right CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch, would be appropriately reported only once in this case since all 3 nerve blocks were administered to the same nerve or branch.

Reader Question
"We are getting conflicting information regarding coding medial and lateral branch blocks S1, S2, and S3, Medial 64493, 64494, Lateral 64493, and 64494. Our Pain Center wants to use facet injection for the medial branch block and other peripheral nerve for the lateral branch block. Are we correct in reporting lateral branch nerve block(s) to the peripheral nerve CPT code?" Yes, you are correct. The lateral branches of the dorsal sacral nerve plexus are considered peripheral nerves. Therefore, for the four lateral branch block injections at S1, S2, S3, and S4, report 4 units of CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch. Report multiple units of the injection for the four lateral branch block injections performed, modifier 59 would not be appended in this case.

Reader Question
"A patient was seen at our facility and underwent a left-sided L5 and S1, S2, S3, and S4 lateral branch nerve block for diagnostic purpose with C-arm fluoroscopy. What are the correct codes for a lateral nerve block?"

So OK, ... based on the operative report a medial branch nerve block was performed at the L5 and a lateral branch nerve block was performed at the S1, S2, S3 and S4

Therefore, it would be appropriate to report CPT code 64493, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapohphyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral, single level, for the L5 medial branch block.

For the 4 lateral branch block injections at S1, S2, S3, and S4, report 4 units of CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch.

References:
CPT Code Books 2018/2019, CPT Assistant Archive, CMS Website and Resources

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