# Genicular nerve block



## ortho1991

Hi all,

I hope someone can help with this op-note.

The patient was brought to the operating room and placed in the supine position on the x-ray
table. The patient's knee was then placed on pillows as tolerated to offset a clear lateral view of
each leg. The skin of the target knee was prepped with a Betadine solution as well as sterile prep
sticks. On the affected knee the superior medial and lateral epicondyle of the femur as well as the
distal aspect of the medial tibial epicondyle was identified as the target zone for the injection
using an AP view. Each of these regions was marked and the skin and subcutaneous tissue of
these regions were infiltrated with several mLs of local anesthesia prior to inserting a 22 gauge
spinal needle. The needles were advanced using fluoroscopic guidance until reaching the mid
level of the femur and tibia confirmed with a lateral view. 0.5 mL of dye was injected at each of
the nerve sites after negative aspiration for air or heme to ensure the needle tip positioning.
Again, after negative aspiration for air or heme, 1 mL of a solution containing 0.25% bupivacaine
and 40 mg of Kenalog was injected at each of the sites. Sterile dressings were then put in place
on the patient to be kept intact for 48 hours. The patient tolerated the procedure well and was
transferred to the recovery room in stable condition.

I beleive its 64450 but not sure if it's one, two or three injections.
Any advice or guidance will be appreciated

Thank you
Cathy


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## Michele Hannon

It would appear there were three areas of interest.....superior medial epicondyle of the femur, superior lateral epicondyle of the femur and the distal medial epicondyle of the tibia.

I would query your physician for clarification and perhaps use it as a teaching point and ask him to help you understand what branches of the genicular he was treating.

Good luck


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## ortho1991

Thank you for your suggestion and taking the time to respond.

Cathy


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## Arlene2022

*genicular nerve block*

I'm billing for these now. I use 64640 genicular nerve radiofrequency ablation x 3 - its 3 levels....if bilateral then I just change the billed amount still using 3 as the units but adding a 50 modifier to the 64640........does anyone else have any other information?


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## dwaldman

On the facility there is an outpatient code edit that creates a return to provider you would bill modifier 50 with a quantity greater than one.

Typically it would need to be on separate lines. So they can accurately process each line at a 150 percent. I follow using quantity one on the physician side with modifier 50 but currently am not billing any procedures under 64640.


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## Vannoyj

*64450 x 3 for geniculate nerve block??*

I've read the other posts but would like to know if any updates have been made for the geniculate nerve block(s)?
..through each needle to anesthetize the superior lateral geniculate nerve, superior medial geniculate nerve, and inferior medial geniculate nerve.   The needles were removed.

Any help is appreciated.


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## dwaldman

I believe it appears reasonable that 64450 or 64640 (non-pulsed)  are appropriate code selections for the procedures. I haven't seen any one on this forum recommend unlisted or seen yet  specific coding guidance from AMA CPT Assistant.


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## dwaldman

AMA has now published some guidance on this particular procedure as seen below in November AMA CPT Assistant:

November 2015 page 11

Frequently Asked Questions:Surgery: Nervous System

Question: When a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, is code 64450 reported three times or just once for the left genicular nerve? 

Answer:It is appropriate to report code 64450, Injection, anesthetic agent; other peripheral nerve or branch, for the genicular nerve block of three branches of this nerve around the knee joint; however, code 64450 is reported just once during a session when performing the injection(s). Although one, two, or more injections may be required during the session, the code is reported only once, irrespective of the number of injections needed to block this nerve and its branches.


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