# Billing a Celiac Plexus block and Celiac Plexus neurolysis at the same time



## pbennett (Sep 29, 2014)

The physician is performing a celiac plexus nerve block, 64530, and then injecting the nerve with a neurolytic agent, 64680.  According to NCCI edits 64530 is a component or 64680 but can be billed with an appropriete modifier.  The physician is certain that we can bill both of these codes together and wants to get credit for the block, but his documention doesn't support either a 58 or 59 modifier. Has anyone billed these 2 codes together and been reimbursed and if so, which modifier did you use.


----------



## dwaldman (Sep 29, 2014)

The NCCI edit is for the same encounter. If the block is followed by the neurolysis then the block would be inclusive and not separately reportable.

The NCCI Edit follows the same guidelines outlined in the AMA CPT Manual, which clearly states diagnostic/therapeutic injections are included in 64600-64681 as seen below:

Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency) (64600-64681) 

64600-64681 include the injection of other therapeutic agents (eg, corticosteroids). Do not report diagnostic/ therapeutic injections separately.


----------



## pbennett (Oct 1, 2014)

Thank you for the reply.  This is very helpful.


----------



## lalauria (Oct 28, 2014)

Can 64600 be billed w/multi units or just 1 unit....I had 3 nerves injected but only one needle insertion...


----------



## dwaldman (Oct 29, 2014)

lalauria, 
Was there separate ablations procedures targeting each individual nerve to capture the 3 separate nerves per a single insertion? Or was there  one ablation per the single insertion encompassing  the 3 nerves?

For 64400 it is per injection for each nerve/nerve branch treated. It is not for capturing to 2 or more nerves with a single injection. This would only be one unit if there is only one injection per AMA CPT Assistant.


----------



## lalauria (Oct 29, 2014)

*64600*

proc reads: 22510 stimulating needle was advanced through the skin next to the supratrochlear orbit. After neg aspiration for heme/air...a RF probe was placed throught the needle...Sensory stim was then used to id needle placement...once needle was appropriately placed the needle injected w/appropriate drugs....the needle underwent RF lesioning....similar proc was then performed of all 3 nerves...needle removed intact...


----------



## dwaldman (Nov 1, 2014)

lalauria, there would have be a more specific description of the separate nerves that were treated to report for the other nerves.


----------

