# Cpt 64510



## beatet66 (May 21, 2013)

Hello, 
could anyone clarify if CPT 64510 could be billed with 2 units and if so should the billing be on separate lines with modifier 59 or one line with 2 units.
I know the code has an MUE of 1 but my provider states he performed this twice at distinct and separate levels. (C6/7 and C7/T1)
Any help would be greatly appreciated.
Thank you!


----------



## dwaldman (May 22, 2013)

I think that it is a good question. I personally don't know the answer, seems like AMA CPT Network question to submit but would need a brief description of the procedure probably so they could get idea of what is being performed.


----------



## beatet66 (May 22, 2013)

Below is the op report for the above procedure:

THERAPY
Preoperative Diagnosis: Complex Regional pain Syndrome, Face
Procedure: Right Stellate Ganglion Block , 64510 X 2
Stellate Ganglion Block performed at 2(two) distinct and separate levels,
C6/7 and C7/T1
Fluoroscopy with interpretation, 77003
After performing a brief physical exam and reconfirming the surgical site, area
was exposed and skin marking were placed.
The area was cleansed on several occasions with betadine solution on three
separate occasions, area was draped in a sterile fashion. Fluoroscopic image was obtained
and clear visualization of the cervical and upper thoracic vertebral bodies were identified,
Image was then centered AP with the tracheal shadow directly centered over the
vertebral bodies. The C6-C7 vertebral bodies were identified and marked. A 25 ga needle
was used to infiltrate the skin with 3 cc of 1% lidocaine which was injected in the
subcutaneous tissue. A 25 ga 1 ½ inch needle was advanced until contact with the
vertebral body of C7 was obtained. Fluoroscopic image was used to guide the needle into
place and away from the lateral recess of the vertebrae.
After negative aspiration to blood, air or fluids a total solution containing 2 cc's of
radio opaque contrast material was injected and visualization of the spread along the
anterior portion of the vertebral bodies was noted with intravascular uptake or spread in
the neural structures was noted, 5 cc's of 0.5% bupivacaine plus 3 mg betamethasone
solution was injected in a slow and continuous fashion at the C6/7 level. The needle was
then repositioned under fluoroscopic guidance until contact with the anterior portion of
the C7/T1 vertebral body was noted, at tht point the procedure was repeat at the C7/T1
level in the exact same dimensions as dictated above, a total solution of 10 cc's of 0.25%
bupivacaine and 6 mg of betamethasone was used amongst both levels.
The needle was then removed and the area was cleansed with a warm moist

Again, any assistance you can provide would be greatly appreciated.
Thank you!


----------

