# Peripheral Nerve Block HELP!!



## HBROCKMAN (Jun 27, 2013)

My physicians are starting a Neuropathy clinic and are wanting to know if they can charge CPT 64450 4 times when they inject the saphenous, posterior tibial, deep peroneal, superficial peroneal and sural nerves.  I understand that they are parts of the sciatic and femoral branches....so would i just charge 2 64450's or would i be able to count each one as an other peripheral nerve.  I am just confused that the code says nerve or branches, and since these nerves fall under the same 2 branches, I do not know how to code this or explain it to them.  I did not find anything on the internet/LCD's that was helpful besides knowing I can bill this code more than once on the same day. 

Thank you for your time and answers!!!!! Please answer !
Heather


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## debbiebeal (Jun 27, 2013)

try 20551


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## HBROCKMAN (Jun 27, 2013)

20551 is for tendons..they are doing nerve blocks????


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## dwaldman (Jul 3, 2013)

You mentioned you checked an LCD, with the below LCD that we have with WPS Medicare J5 I don't believe that service would be covered. But 4 separate other peripheral nerves, separately injected, with a clear cut procedure note individually describing the performance of each injection with identification of the nerve injected, I believe you could report for the 4 nerves you mentioned. But 64450 x 4 without LCD or medical policy, would still draw my eye if I was reviewing claims for a carrier ---to want to see the procedure note and indications for service.

Local Coverage Determination (LCD): 
Nerve Blocks for Peripheral Neuropathy (L32565)
http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=32565&ContrId=148

Coverage Indications Limitations and/or Medical Necessity

Nerve blocks cause the temporary interruption of conduction of impulses in peripheral nerves or nerve trunks by the injection of local anesthetic solutions. 

The use of nerve blocks or injections for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically necessary. Medical management using systemic medications is clinically indicated for the treatment of these conditions.

At present, the literature and scientific evidence supporting the use of peripheral nerve blocks or injections in multiple neuropathies or underlying systemic diseases that are producing peripheral neuropathies, especially for the Medicare population, is insufficient to warrant coverage. These procedures are considered investigational, and are not eligible for coverage for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases.


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## hstrasko_rn@atlanticlegalnurseconsultants.com (Jul 5, 2013)

*Peripheral Nerve Block*

It would be of benefit to submit your Anesthesia's Drs. OR notes, H & P along with this claim. Also, you might try adding modifier -51 to the CPT codes. "It is used when multiple procedures, other than E/M servives, Physical Medicine and Rehab services or provision of supplies, (vaccines) are preformed at the same session by the same individual, the primary procedure or service maybe reported as listed."  "The additional procedure or service maybe identified by appending modifier 51 to the additional procedure or service code(s)." "This should not be used of "add-on" codes or services." 
_*CPT Assistant-Feb 09:6, Mar 09:10, Apr. 09:8, CPT Changes, An Insider's View 2008, 2013. _

Incidentally, **Dr maynot receive full payment for these services.  Best of luck.
H.Strasko, RN, CLNC


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