# How to bill GENICULAR NERVE BLOCK & RF NEUROTOMY OF KNEE JOINT



## Milrivera2121 (Jan 15, 2015)

THis is the first time my dr is performing this procedure and im unsure how to go about billing this . it will be a cool genicular nerve block  in office out patient procedure for the knee everything i see is referring to lumbar im just so confused . please someone help


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## Christine72 (Jan 15, 2015)

*Genicular nerve blocks*

Milrivera2121,

Our pain MD's started these geniculate injections in the knee last year. They were confusing to me as well. I have some information from Kimberly Clark that my pain MD gave me. 

CPT code 64640:
Destruction by neurolytic agent, other peripheral nerve or branch

We use 64640. You bill for each nerve denervated (3 x 64640)
(you also can bill bilateral with the 50 modifier)

* Superior lateral geniculate lesion
* Superior medial geniculate lesion
* Inferior medial geniculate lesion

Bill for fluoroscopic guidance: 77002-26

I hope this helps.


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## Milrivera2121 (Feb 11, 2015)

*Thank you*

Jackie C Moore CPC

   Thank you so much for your reply and help !!   thank you thank you


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## scaston (Sep 18, 2017)

*Genicular Nerve Radiofrequency*

We understand that there was a discussion on whether to bill 3 nerves for the genicular block (64450) or to bill on 1 as a branch.  Does anyone have anything on the Radiofrequency Ablation (64640)of the genicular nerve(s) as to whether there would be 3 or 1 units billed?  thanks,


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## angiewelbern@cox.net (Nov 3, 2017)

scaston said:


> We understand that there was a discussion on whether to bill 3 nerves for the genicular block (64450) or to bill on 1 as a branch.  Does anyone have anything on the Radiofrequency Ablation (64640)of the genicular nerve(s) as to whether there would be 3 or 1 units billed?  thanks,



Found this on another's post regarding this same subject.  dwaldman deserves the credit for locating this info:

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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