# Genicular block vs. RFA # of injection to bill for



## jls4567 (Jul 2, 2018)

Hi all,
I have a PAIN physician that is questioning how many injections can be billed for the genicular nerve block (64450) and the RFA (64640).
She is injecting 3 times for both the blocks and RFA's
I have found CPT Assistant references for both and for the 64450 it states to bill once and for the 64640 it states that 3 can be billed.  I know that she will question why the references are different when it is the same nerves being treated for both procedures. 
Does anyone have any guidance on this?

Block:
_CPT Assistant, November 2015 Page: 11 Category: Frequently Asked Questions
Question:
When a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, is code 64450 reported three times or just once for the left genicular nerve? 
Answer:
It is appropriate to report code 64450, Injection, anesthetic agent; other peripheral nerve or branch, for the genicular nerve block of three branches of this nerve around the knee joint; however, code 64450 is reported just once during a session when performing the injection(s). Although one, two, or more injections may be required during the session, the code is reported only once, irrespective of the number of injections needed to block this nerve and its branches._

For the RFA:

_The January 2018 CPT Assistant issue included this Q&A:
Question: What code(s) is used to report an injection on the superior medial and lateral branches and the inferior medial branch of the left genicu-lar nerve performed for destruction with a neurolytic agent?
Answer: Code 64640, Destruction by neurolytic agent; other peripheral nerve or branch, may be reported for each nerve destruction. Therefore, if destruction is performed on the superior medial and lateral branches and the inferior medial branch of the left genicular nerve, it would be appropriate to report code 64640 three times or report code 64640 once with three units of service based on payer preference. The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings of code 64640 to separately identify these procedures._


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## karras (Jul 8, 2018)

I've had the same issues but I can't found any other guidance that explains the rationale.

Kim


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## jkyles@decisionhealth.com (Jul 11, 2018)

Hi,

I've seen a number of questions about this because it is pretty … kooky. Unfortunately, the only reason is that the AMA has said that's the way blocks should be reported.  

The only thing I can suggest is submitting a question to CPT Assistant - there will be a fee - that asks for an explanation of the difference between the blocks and RFA.


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## marvelh (Jul 18, 2018)

Be on the watch for new specific genicular nerve procedure codes to help clarify these conflicts. Unfortunately, however, they will likely not be coming until 2020


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## Urvishah (Aug 29, 2018)

I am looking for the number of Units - 64450 - and if 3 injections then should i use 3 units????? or only 1???


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