# 64450 after C-section (peripheral nerve or branch block)



## tstelma (May 31, 2013)

I am seeing a lot of appeals for this pain management code, as it is in addition to the 01961 general anesthetic for the C-section. The billers believe the Drs name on the "requested by" line on the form and a Dx code of 338.18 (other acute postoperative pain) is sufficient to bill as a 64450-LT-59 and 64450 RT-59. It seems to me some more specific documentation from the doctor should be necessary. Thoughts? Thanks.


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## dwaldman (Jun 3, 2013)

The billers believe the Drs name on the "requested by" line on the form and a Dx code of 338.18 (other acute postoperative pain) is sufficient to bill as a 64450-LT-59 and 64450 RT-59.

What does the above sentence refer to. Is there a procedure note for the service provided, what peripheral branch are they blocking bilaterally. Why are you not using 50 modifier?


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## tstelma (Jun 4, 2013)

I only have the anesthesia report to work with. I did find the answer to this in the NCCI policy manual. It states the nerve block can be adminstered along with the general anesthesia and billed with modifier 59whether adminsitered preoperatively, intraoperatively, or postoperatively. 

RT, LT, Modifier 50 on a single code, code twice - modifier 50 on second one...it all depends on the payer's preference. I am working on appeals, and the RT/LT is how I received it.
Thanks


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## dwaldman (Jun 5, 2013)

If you are working on appeal. I guess the question to ask yourself does the documentation support that there is a actual procedure note describes the injection of bilateral other peripheral nerves. Is the documentation authenticated by the provider you who performed the service. If all you have is anesthesia records stating, Dr X administered bilateral peripheral nerve blocks and that is it. Then you might need to request the physician to a formal procedure note.


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