# occipital block and Rf



## jessieindiego (Aug 25, 2010)

Doctor wants me to bill for the occipital nerve block (64405) and the pulsed RF (64999) can i bill for these separately? 


DESCRIPTION OF PROCEDURE: The patient assumed a prone position in the minor surgery area of my office.  
The external occipital protuberance and the superior nuchal line and occipital artery were identified by palpation. Next, the patient's hair and scalp were thoroughly cleansed using an aseptic technique. A 25 gauge, 1 1/2 inch needle was inserted medial to the occipital artery, or approximately 2.5-3 cm lateral to the external occipital protuberance. The area was anesthetized using 1% lidocaine.  Then using a 22 gauge 5 cm RFK insulated needle which was then directed along the same path which was anesthetized.  Paresthesias were not elicited along the ipsilateral temporal-occipital distribution during needle insertion.  Then using radiofrequency stimulation at 0.4 MA at 50 Hz a Paresthesia was elicited.  Pulsed radiofrequency was then performed at 44 degrees Celsius for 120 seconds.  Then after negative aspiration for heme, 5 ml solution containing 0.5 ml of 40 mg/ml (20 mg) triamcinolone and 4.5 ml of 0.25% bupivicaine was injected in a fanned-out distribution. 
There were no apparent complications. The patient tolerated the procedure well and was carefully escorted to the recovery room in stable condition. The patient did have a sensory block after the examination. 
The patient appeared to tolerate the procedure well.


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## dwaldman (Aug 27, 2010)

If this was non pulsed RF of the occipital nerve you would be using 64640 and 64405 is a column two code with modifier not allowed. If you look at your Medicare LCD for billing RF of the spine in the Coding and billing guidelines. They will most likely have something that says injection of the nerve is considered inherent in the RF procedure and not separately reportable.

When you use the compare code 64640 to assit the carrier in pricing the 64999, you can not also bill a code that is bundled into your compare code.


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