# 64450 with Fluoroscopy??



## Jennifer17 (May 9, 2017)

Hello I am new to pain management and our doctor does many genicular blocks under fluoroscopy- but code 77002 is an add-on code now and apparently 64450 is not a primary code for the usage of fluor- so how would we bill for it?? just the 64450 and not bill for 77002?
thanks in advance


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## Melissa Harris CPC (May 9, 2017)

You can only bill for the injection.  Fluoroscopy is included in the injection charge.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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## Jennifer17 (May 9, 2017)

ok thank you  - I kind of assumed so, but it does not say it in the CPT code description so I wanted to be sure


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## tatumroe (Aug 19, 2017)

*64450*

Jennifers, we have a new pain management doctor and want to be sure we understandthat although he treated 3 different branches of the same nerve we can only bill the code once witb 1 UOS. Could you confirm this is how you bill? And in what instanceswould you code for more than 1 UOS and is it multiple lines with a 51?


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## dwaldman (Aug 19, 2017)

Tatumroe,

You are reviewing the definition of "nerve or branch" from the code descriptor of CPT 64450 and was requesting an example. I believe an example would be two separate nerve blocks of two separate other peripheral nerves that fall under 64450 could be an example. Here previously from CPT Assistant addressing division or branch, additionally the fact the genicular nerve is three separate injections but only one unit is recommended, You might need to purchase a CPT Network account with the AMA to get formal responses if the procedures are commonly performed by your provider to ensure that although it might pass the MUE edit, that the appropriate use of the code is be utilized.

AMA CPT Assistant December 2008

Question: If a provider injected two separate unilateral branches or divisions of the trigeminal nerve (eg, injected the right supraorbital
branch [V1] and also injected the right infraorbital branch [V2]), would these injections be reported as two units
of code 64400 or just one unit, as the code description states “any division or branch”?
Marvel J. Hammer, RN., Denver, CO

Answer: Code 64400 should be reported once for the injection into the right supraorbital nerve. Code 64400 with modifier 59, Distinct procedural service, appended
should be reported for the right infraorbital branch injection. The descriptor of code 64400 represents a single injection into a single nerve in the anatomy and sensory distribution of the peripheral trigeminal nerve. Injection of each specific nerves has effects on different anatomy
sensation in different areas. An understanding of the neural distribution is key, since the right supraorbital nerve is above the orbit
of the eye (about at the level of the eyebrow on the forehead), whereas the infraorbital nerve is below the orbit (lateral to the nose, middle of the face, and midline
with the pupil of the eye). To illustrate, the trigeminal nerve is the main cutaneous sensory nerve of the face and head, with three main
branches (V1, ophthalmic; V2, maxillary; and V3, mandibular), each with its own nerve divisions. The right frontal nerve is a continuation of the ophthalmic nerve.
The right supraorbital nerve leaves the orbit through the supraorbital foramen, providing filaments to the upper eyelid and the frontal muscles. The right infraorbital nerve is in the maxillary branch of the trigeminal nerve. The maxillary nerve becomes the infraorbital nerve, which emerges onto the face through the intraorbital foramen, thus providing cutaneous innervation to the middle  of the face, lower eyelid, side of the nose, and upper lip


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