# CPT for intercostobrachial block ?



## betsycpcp (Sep 28, 2020)

I can't find much guidance on how to code an intercostobrachial nerve block.  I've seen 64420 which is for "intercostal," and 64450 (other peripheral nerve or branch).  Descriptions of intercostal blocks say they are for surgery around the chest and abdominal wall, and the injection is done in the area of the ribs.  Intercostobrachial blocks are done on the inner arm near the armpit and are used for upper arm surgery.  

I'm leaning towards 64450 since the indications and the location for intercostobrachial don't seem to match the information I found for 64420, but I see it billed under 64420 frequently.  I tried google and the only thing I found that seemed to specifically addressed this was on ZHealth which you can't see without a membership.


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## lcole7465 (Sep 29, 2020)

We bill 64420 for the intercostobrachial NB


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## betsycpcp (Sep 29, 2020)

On Wikipedia it says  the lateral cutaneous branch of the second intercostal is named the intercostobrachial nerve.   So since it's a branch, I thought 64450 might apply.  I saw one answer in an old thread in this forum that said 64450 and had a link, but the link was not valid any more.  I do see 64420 more often, so I think I'll assume that's the correct one unless someone has other information.

Thanks


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## marvelh (Sep 30, 2020)

Per NYSORA, https://www.nysora.com/techniques/upper-extremity/distal-nerves/cutaneous-blocks-upper-extremity/ this appears to be more of a peripheral nerve block rather with the injection performed in the upper arm than an intercostal nerve block that is performed in the chest wall with needle placement just under the rib(s).  I would review the procedure note for needle placement and that should help with the appropriate code.


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## betsycpcp (Oct 2, 2020)

Thanks for that link.  I don't think the note I saw had a detailed description, but it was a post-op pain block done along with an interscalene block for some type of shoulder or arm surgery if I remember correctly.  That's why I thought 64420 didn't seem appropriate, since intercostal blocks are described as being for chest and abdominal pain.  But I couldn't find anything clearly saying not to use 64420 for intercostobrachial.  I saw that the intercostobrachial nerve is a branch of the 2nd intercostal nerve, but since it's a branch and not the intercostal nerve itself, it does seem like that supports using 64450.  
I work for a payer and I have denied several bills with 64420 stating the code didn't match the documentation, but I keep seeing it billed that way so I was questioning myself.


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