# Lesser Occipital Nerve Block



## cynthiss

Two questions: Should a lesser occipital nerve block be billed 64450ther peripheral nerve or branch? The greater occipital block CPT code is 64405 (no mention of lesser). Is the greater and lesser occipital nerves actually two separate nerves or are they joined together at some point?


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## marvelh

The lesser occipital nerve originates from the lateral branch of ventral portion of the C2 and sometimes the C3 spinal nerve.  It provides sensory innervation to the lateral scalp area behind the ear.  Report with 64450 as there isn't a specific code for lesser occipital nerve injection

Whereas the greater occipital nerve originates from the medial branch of the dorsal portion of the C2 spinal nerve and provides sensory innervation to the midline back of the scalp area. Report with 64405 

Here is a link for an illustration that shows the two separate nerves: http://2.bp.blogspot.com/_yujaake5T...A6w/s320/Skull+block+for+awake+craniotomy.bmp


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## cynthiss

Thank you, your assistance in this is "greatly" appreciated!!


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## christyboutwell

*occipital nerve block*

If the doctor states he  injected both greater and lesser occipital nerves, would I then bill for both 64405 and 64450? If he doesn't state a specific nerve he injects and calls the procedure an occipital nerve block, would you code for the GONB 64405?


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## dwaldman

christyboutwell , 

I would recommend that you relay to the physician he needs to document greater occipital nerve if that is the nerve targeted in the procedure he performed for billing 64405. 
When reviewing the RVUs of 64405 which is 1.82 with around a $65.16 reimbursement for a unilateral injection. Compared to the CPT 64450 with an RVU of 1.31 with around a $46.90. Which could be around a 20 dollar overpayment if not properly documented and only the lesser was blocked.

With the difference in reimbursement, you want to make sure you are correctly reporting to the carrier 64405 only for greater occipital nerve blocks if you are billing for a provider who also blocks the lesser occpitial nerve in some situations. 

Although 64405 and 64450 do not have a code edit with CMS NCCI. I would ensure that that the consent for the procedure includes both the greater and lesser occipital nerves and the procedure note clearly describes both sets of nerves being separately injected and potentially reasoning why the lesser will also be targeted in addition to billing for the injection of the greater occipital nerve. I have personally only billed for the greater occipital nerve under 64405 and not the dual procedure of greater and lesser so I am not fully research carriers response to being billed for both the greater and lesser occipital nerve.


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