# Mellick Block



## kewing (Aug 26, 2014)

Looking for some guidance in coding this procedure.  After consulting several physicians and doing some web research, I am far from clear on whether this is intended to be a nerve block or a trigger point injection.  The ER physician who did the injection feels it might be a nerve block.  A neurologist whom I consulted says it is not a nerve block and would be more appropriately coded as a trigger point injection; however, he has stated that is his opinion, and not an authoritative answer. 
Does anyone have sufficient knowledge of this procedure, or an authoritative reference, to give guidance in coding it?
Thanks much!


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## dwaldman (Aug 27, 2014)

What is being injected. If the note supports this is intra muscular injection then the trigger point injection could capture this technique. If final delivery of drug combination is at a target site of a nerve then it could fall under 64450 or a specific CPT for a particular nerve that is targeted. I was unable to find  published article stating the CPT code selection for the mentioned procedure.


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## mzprince2002 (Feb 17, 2017)

*mzprince2002*

Several ED coders (former Paramedics & RNs) researched this together.  After much debate this is what we decided...62281 "Injection/infusion of neurolytic substance, with or without other therapeutic substance; epidural, CERVICAL, or thoracic.  

Here is a link with a good description of the procedure. 
http://nurse-practitioners-and-phys...ating-Headaches-With-Cervical-Injections.aspx


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## marvelh (Feb 21, 2017)

Actually, the code 62281 is used to report an injection of a neurolytic, such as absolute alcohol or phenol into the epidural space to denervate the spinal cord at that level.  

It is not used to report  injection(s) of local anesthetic into the cervical muscles, such a a Mellick block, for headaches - 
http://epmonthly.com/article/how-to-use-paraspinous-injections-for-complex-headaches/ 

http://socmob.org/2014/01/paraspinous-cervical-block-headache/

versus http://medcraveonline.com/JACCOA/JACCOA-06-00244.pdf that would more likely be reported with either the 62281 or 62282 code depending upon the spinal region.

I would recommend reviewing one of the trigger point injection codes, such as 20552 or 20553, depending upon the number of muscles that were injected.


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