# Intercostal Nerve Blcok



## lump2009 (Apr 1, 2010)

If the doctor did the T5-6  intercostal nerve block would I bill 64421 once or would i bill 64421 twice


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## rkmcoder (Apr 1, 2010)

Code 64420 once for a single stick.  Code 64421 once for multiple sticks.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## vj_tiwari (Apr 1, 2010)

I think once.

Be'coz, 64421 says... intercostal nerves, multiple, regional block.

And you are mentioned T5-6. (two. so not 64420).


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## dwaldman (Apr 1, 2010)

"The physician anesthetizes the intercostal nerve to block chest wall pain. In 64420, a single injection is performed. In 64421, multiple nerves are injected to provide pain relief to a larger area (regional block)."

From Encoder, this description I feel helps clarfiy that 64421 is only billed once for mulitple nerves.


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## marvelh (Apr 2, 2010)

In a T5-T6 intercostal nerve block, the physician is blocking only a single intercostal nerve, T5, that is in the T5 & T6 interspace aka between the fifth and sixth thoraic ribs.  So if the documentation is a dash, then it would be a single injection or 64420.

If the physician performed T5 and a T6 intercostal nerve blocks, he would be blocking not only the T5 intercostal nerve located as above between the T5 & T6 interspace but also a second injection to block the T6 intercostal nerve in the T6 & T7 interspace aka between the sixth & seventh thoracic ribs.  Since more than 1 intercostal nerve injection was performed, this would be a multiple block or 64421.

The key is - Is the physician describing the needle placement location: T5-T6 or the specific intercostal nerves blocked: T5, T6.  Something as simple as a dash or comma can change the coding - that is why it is important that we can't code from a procedure title but also need to verify the procedures in the procedure documentation detail section and/or confirm with the physician.


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## dwaldman (Apr 2, 2010)

Thanks for explaining this I totally missed that point when I responsed.


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