# Optic Nerve Block for Pain management



## bruxy83@gmail.com (Jul 31, 2013)

I am new to the coding field and was asked to research a CPT code for an Optic Nerve block used for pain management for migraines. PLEASE HELP!


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## LeslieJ (Jul 31, 2013)

*Optic nerve*

Do you have any notes?

Does your physician mean occipital nerve block?  64405?

L J


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## dwaldman (Jul 31, 2013)

I also not familiar with an optic nerve block but did see the following on an internet search since you mentioned migraines. Did not found a lot more information then this.

http://ehealthforum.com/health/optic-nerve-block-injections-t251410.html


how does optic nerve block injections work?

It's long been known that light makes migraines worse.Nearly 85 percent of migraine patients are also extremely sensitive to light, a condition known as photophobia.Extremely disabling, photophobia prevents patients from such routine activities as reading, writing, working or driving. 
 The mechanism of photophobia must involve the optic nerve, because in totally blind individuals, the optic nerve does not carry light signals to the brain.A group of recently discovered retinal cells containing melanopsin photoreceptors [which help control biological functions including sleep and wakefulness] has been shown to be critically involved in this process, because these are the only functioning light receptors left among patients who are legally blind. 
 Clinically, this research sets the stage for identifying ways to block the pathway through the optic nerve to the brain so that migraine patients can endure light without pain. 

Read more: Headache and Migraines Forum - Optic nerve block injections http://ehealthforum.com/health/optic-nerve-block-injections-t251410.html#ixzz2agsKN64r


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## dwaldman (Jul 31, 2013)

http://www.nysora.com/regional_anes...hamology/3118-anesthesia_for_eye_surgery.html

In the above link they describe a separate procedure than what you are describing but they do describe complications from needle trauma to the optic nerve, which questions if what you researching requires a similar approach as what is being describe in the above link.  And further research to determine if there are studies to support the benefit outweighs the risk.


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## bruxy83@gmail.com (Aug 2, 2013)

Honestly I am so new to the coding profession (3 months) and my boss handed me a post it asking if we can bill for: Pain mamangement for Migraines via Optic Nerve Block. 
The only code I could find in the CPT book was 64450: Injection, anesthetic agent; other peripheral nerve or branch. 
Lay Description: The physician anesthetizes a nerve to provide pain control or blockage. The physician draws a local anesthetic into the syringe and injects it into the branch of the nerve to be anesthetized. This code is used to report nerve blocks of other nerves not specifically listed in this section. 

** Since this had 'other' in the description I felt that this was the only option. 

Any thoughts?


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## johnmeyer (Aug 4, 2013)

It depends... Use 64405 for a greater occipital nerve block. Use 64450 for a lesser occipital nerve block. Our PM doc usually does both for migraines, but you're going to have to go back to ask if your PM doc did a greater or lesser occipital nerve block or both because ours doesn’t always do both for a migraine. You're also going to need laterality (-LT/-RT) like you would for something like a major joint injection (20610). The only difference between something like a 20610 and 64405/64450 is that you’re going to have to use mod -50 for bilateral. This is the only way we’ve gotten payment for a bilateral occipital nerve block.


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## bruxy83@gmail.com (Aug 5, 2013)

Thanks so much John, I have forwarded your advice to my director. I appreciate your time in helping me out.


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## bruxy83@gmail.com (Aug 5, 2013)

Hi John, my director asked if your doc is an Anesthesiologist? If not, who is performing this part?


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## marvelh (Aug 6, 2013)

It could also be instead an Opthamlic nerve block, which is the V1 division of the Trigeminal nerve.  This branch is also sometimes blocked in treating migraines.


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## dwaldman (Aug 6, 2013)

Bruxy83@gmail.com,
Which nerve  or nerves does the procedure note state is being blocked?

Optic nerve?
Greater Occipital Nerve? 
Lesser Occipital Nerve?

The reason I ask is your heading to your post states the optic nerve block, but there seems to be some indication that your procedure note might be regarding either a greater or lesser occipital nerve block.


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## dwaldman (Aug 6, 2013)

Bruxy83@gmail.com,

Or confirm if this the Opthamlic nerve block as the post above also mentions. Is there a way you can provide the procedure note if you have time to retype on this forum. It would be interesting to find out what it ended up being.


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## dwaldman (Aug 6, 2013)

Sorry, now that I read your initial post, I see that you are reviewing the coding for particular procedure that you do not have a procedure note for but just reviewing what CPT would represent the service. Potentially after you do confirm with the physician you are working with the actual nerve that will be blocked in question then maybe you can share which the nerve that is being targeted is that provider is inquiring about.


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## bruxy83@gmail.com (Aug 6, 2013)

@ DWALDMAN:

They havent given me an op note, I believe they want to know if we can bill for it under the physicians side. I wasnt given much information.


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## johnmeyer (Aug 7, 2013)

bruxy83@gmail.com said:


> Hi John, my director asked if your doc is an Anesthesiologist? If not, who is performing this part?


 

He is. He's the one who performs all injections for our pain managment clinic. Here's his information from our web site...

http://heekinortho.com/about/physicians/sternberg


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## bruxy83@gmail.com (Aug 12, 2013)

dwaldman said:


> Bruxy83@gmail.com,
> Which nerve  or nerves does the procedure note state is being blocked?
> 
> Optic nerve?
> ...


Hi DWALDMAN, 

I wasnt given a procedure note, just a post-it with this question. It was very broad. I appreciate everyones advice.


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