# Genicular Nerve block



## karras (Dec 14, 2016)

Does anyone have some expertise at coding genicular nerve blocks?  We have a new pain physician who lists out the nerves which aren't of genicular origin (that I could find) and wants to bill 64450 x3 rather than 64450 x1 for the genicular block.
These are the nerves he lists: superolateral nerve from the vastus lateralis, the superomedial nerve from the vastus medialis and the inferomedial nerve from the saphenous nerve.  

I guess where he came from they blocked those nerves rather than the three branches of the genicular nerve.  Does anyone have any helpful advice?

Thanks.
Kim


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## Melissa Harris CPC (Dec 15, 2016)

We perform these injections and bill x 3 as 3 separate branches of the genicular nerve were blocked.  I do get some denials but when I appeal with rationale they end up paying.  This also works for Genicular Radiofrequencies.  


Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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## karras (Dec 16, 2016)

Thank you!
Kim


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## dwaldman (Dec 22, 2016)

Here is some references I am aware of regarding this procedure, From the CMS NCCI Policy Manual from 2017 it states only one unit can be billed:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

CHAP8-CPTcodes60000-69999_final103116.doc Revision Date: 1/1/2017 

(2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches. 

________________________________________
AMA CPT Assistant November, 2015
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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