# Intercostal nerve injection 64420 vs 64421



## hofm04 (Jun 7, 2017)

64420 single injection,  64421 multiple -  Each of these codes has a MUE of 3 per date of service.   
I have injection to the T3,4,5 intercostal.  Is this 64420 x 3 since these are in 3 separate sites or 64421 multiple injections.   
I read an older post that said to use 64421 x 1.  If that is true, then why would here be an MUE of 3 on 64420.    I would think 64421 is if you inject multiple sites of the same nerve.  
Any insight?


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## hofm04 (Jun 7, 2017)

adding this article     CPT Assistant November 2010

 Surgery: Nervous System

 Question:If a single injection is performed for a thoracic intercostal nerve block, the effect of which is to block multiple intercostal nerves, it is appropriate to report CPT code 64421,Injection, anesthetic agent; intercostal nerves, multiple, regional block,or is the provider limited to re-porting code 64420,Injection, anesthetic agent; intercostal nerve, single?

 Answer:From a CPT coding perspective, single injection” means “single nerve block.” Therefore, code 64420 should be reported. If only one needle is placed into the skin but manipulated up and down to inject into more than one nerve, it may be possible to report multiple blocks (code 64421). However, from a clinical perspective, blocking multiple intercostal nerves with a single injection is hard to do in most settings.


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## dwaldman (Jun 11, 2017)

to the T3,4,5 intercostal

I believe if multiple intercoastal nerves are blocked such as T3, T4, T5 then CPT 64421 would be used with one unit of service. The plural form of the code descriptor for CPT 64421 would support that it encompasses multiple nerves being treated; whereas, CPT 64420 has intercostal nerve in the singular. The MUE might be available of 3 to support if the patient is in the hospital and in separate encounters on the same day the procedure has to be repeated.


64421  
Injection, anesthetic agent; intercostal nerves, multiple, regional block  


64420  
Injection, anesthetic agent; intercostal nerve, single


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