# Digital and Posterior Tibial Nerve Blocks



## Melissa Harris CPC (Jan 31, 2014)

I need help coding the following.  The patient had two procedures, a rigth tibial nervo block at the popliteal fossa and a right hand injection.  


PROCEDURE:    Right Tibial Nerve Block at the Popliteal Fossa 		
ANESTHESIA: Local
PRE & POST OPERATIVE DIAGNOSIS: 729.2 Neuralgia/Neuritis/Radiculitis Unspec
INDICATIONS: Right Foot pain

DESCRIPTION OF PROCEDURE:  DESCRIPTION OF PROCEDURE:  After informed consent was obtained, the patient was brought to the procedure room and placed on the procedure table in the prone position.  The  Right popliteal fossa was identified using a skin marker. a mark was made in the midline 7 cm cephalad to the crease.  A skin wheal was raised at this point using 1 cc of Lidocaine. Using a nerve stimulator a 22 gauge stimulator needle was passed throught the skin wheal perpindicular to the skin until ankle dorsiflextion begins.   The needle was aspirated prior to injecting the above injectating 2 cc's .25% Marcaine and 1 mg of 40 mg/mL Kenalog.   The needle was removed and a Band-Aid was placed on the injection site.  The patient tolerated this procedure well.  There were no complications.


PROCEDURE: RIGHT HAND DIGIT INJECTION
ANESTHESIA: Local

PRE-OPERATIVE DIAGNOSIS: 729.2 Neuralgia/Neuritis/Radiculitis
POST-OPERATIVE DIAGNOSIS: 729.2 Neuralgia/Neuritis/Radiculitis
INDICATIONS: RIGHT HAND PAIN

DESCRIPTION OF PROCEDURE: After written informed consent was obtained from the patient and benefits and risks discussed including but not limited to: Benefits being pain relief.  Risks being infection bone nerve damage intravascular injection causing infarct of soft tissue.

The patient is brought to the procedure room and is seated on one of the chairs.  His right hand is placed on the procedure room table, and it is prepped with Betadine in sterile fashion.  Injection is performed on either side of the each of the digits stumps utilizing a half cc on each side of a mixture of 1 mL of 6mg/mL Celestone and 4 cc of 0.25% Marcaine, and 1 mL 1% Lidocaine. Needle is removed puncture wounds were dressed patient tolerated the procedure well.


Any help is greatly appreciated!

Melissa Harris, CPC


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## dwaldman (Feb 1, 2014)

64450 RT 729.2 719.47
64450 51 RT 729.2 719.44

with additional note on the claim: Two separate injections Hand and Leg

*modifier selection could vary per carrier. For example, WPS Medicare J5 it is my understanding if the code pair does not have a NCCI bundling edit then 59 should not be used.


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## Melissa Harris CPC (Feb 3, 2014)

Thank you!  That is what I was thinking but wanted to make sure.


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