# Blocks with Neurostimulation



## vanessa10 (Dec 15, 2009)

I have a couple charts where the Dr is doing a single interscaline block with neurostimulation guidance. Is there a cpt for neurostimulation guidance???


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## marvelh (Dec 16, 2009)

The use of a peripheral nerve stimulator to verify anatomic needle placement is included in the vast majority of nerve injections.  Chemodenervation injection procedures, CPT codes 64612-64614, are an exception as the add-on code,+ 95873, for electical stimulation for needle guidance can be billed.  

The following is an excrept from NCCI Chapter 1 "General Coding Priniciples":
"...Examples of services integral to a large number of procedures include:...


Surgical approach including identification of anatomical landmarks, incision, evaluation of the surgical field, debridement of traumatized tissue, lysis of adhesions, and isolation of structures limiting access to the surgical field such as bone, blood vessels, nerve, and muscles including stimulation for identification or monitoring..."​
and the following is the vignette from the February 2004 CPT Assistant for 64415:
After obtaining informed consent, the patient's right arm is abducted at the shoulder and flexed at the elbow with his hand positioned above his right shoulder. The axilla is prepped with a betadine solution and a 22-gauge, short-bevel needle inserted into the brachial plexus sheath after anesthetizing the skin with a small amount of local anesthetic. *The proper location of the needle is ascertained with the use of a nerve stimulator*, the elicitation of paresthesias, or the transarterial technique. An axillary block using the injection of 30-40 ml of local anesthetic is now performed after using a small test dose of the local anesthetic and frequent aspiration during the injection. The density and function of the block is then assessed over the next 30 minutes. Active physical therapy to the hand and digits is administered while the patient's arm and hand are anesthetized. 
​and from NCCI Chapter 2 "
"...Examples of integral services include, but are not limited to, the following: 


Nerve stimulation for determination of level of paralysis or localization of nerve(s). (Codes for EMG services are for diagnostic purposes for nerve dysfunction. To report these codes a complete diagnostic report must be present in the medical record.)..."​


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