# Nerve block & trigger point injections



## lmfort (Jun 4, 2014)

This is the first time our office has done an occipital nerve block injection AND trigger point injections. My physician wants to know if we can bill both 64405.50 and 20552 (bilaterally - 4 injections) together and if he can bill 99213-25 with that? Also he used Kenalog-40 and Marcaine. Can we bill for those? Insurance is BCBS. 

Below is an excerpt of his note to get a better picture:

-primary complaint of seizure as well as bilateral neck and head pain.
-bilateral neck and occipital pain is worse, neck is stiff, there is bilateral shoulder pain.
-Neck pain and occipital neuralgia-C spine series with DJD. Interested in injection. Permit signed. Given Marcaine 0.5% 9 cc as well as Kenalog-40 1cc- injected over the bilateral occipital nerves as well as 2 trigger point locations in the lower cervical spinal area bilaterally (four injections).

Any help is GREATLY appreciated!


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## sparkles1077 (Jun 8, 2014)

Local anesthesia would be included in the global surgical package

The E and M service is also bundled in the surgical package, unless it is a separately identifiable service.  For example, patient is seen and examined for a separate diagnosis.

I think the CPT codes 64405-50 and 20552 look good.


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## ollielooya (Jun 8, 2014)

Careful, as the edits will bundle if these two codes are billed together.  A modifier 59 may be needed on the 20552.  Also it is my understanding that the Kenalog can be billed separately, but the Marcaine is included within the surgical package.  Someone please correct me if I am wrong...


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## sparkles1077 (Jun 11, 2014)

I agree there should be a mod 59 on 20552.  I am not sure about the Kenalog, I was only speaking for the local anesthesia (Marcaine)


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