# Pain Management Injection



## AR2728 (Jan 10, 2013)

Pain Management is completely new and foreign to me.  Physician marked 64405 and 62280-50 on the superbill.  Are both of these to be billed for the following procedure?

_...head flexed forward during injection.  All pressure points were padded and the neck was prepped and draped in a sterile fashion.  Hypodermic needle was advanced until reaching the periosteum, follwed by injection in a fan like distribution to cover Right greater and lesser occipital nerve.  Repeated aspirations throughout the injection were negative for air, CSF and blood with incremental attempts.  Medication as mentioned above (20 mg Depo-medrol) was then injected covering the Right greater and lesser occipital nerve.  The same procedure was done on the Left side. _ 

Would this be billed as 
64405
62280
62280-50


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## AR2728 (Jan 15, 2013)

Any pain managment coders out there who can help?


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## Michele Hannon (Jan 15, 2013)

I am not a pain management guru. That being said it would appear that the documentation provided may possibly support 64405-50.

It does not appear that there was any subarachnoid injection as is required for 66280.


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## marvelh (Jan 15, 2013)

64405 is for greater occipital nerve injections and 64450 would be used for separate and distinct lesser occipital nerve injections.  However, the documentation appears to indicate that only 2 separate injections not 4 injections were performed.

As noted by a previous post, the documentation does not support that a subarachnoid injection was performed but additionally, it does not indicate that a neurolytic substance was injected, rather only a steroid


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## AR2728 (Jan 16, 2013)

In error I left off that he injected .5% Bupivacaine-3cc, which would be the neurolytic, correct?  I'm assuming this now changes what will be billed.  So does this leave me billing 64405 for both RT and LT and that is all?

Another question--In Pain Management coding is the Bupivacaine separately billable/reimbursed?  I am so very lost on all this pain coding.


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## marvelh (Jan 17, 2013)

5% Bupivacaine is a local anesthetic not a neurolytic.  it is similar to Lidocaine or xylocaine, it just has a longer duration


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## AR2728 (Jan 17, 2013)

Thanks for your patience.  I'm completely out of my league on this and unfortunately this is an outreach clinic, so the physician is only here 1 1/2 days a month.  It's left me hanging on my own.


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