Anesthesia Coding Alert

Question: Our physician administered blocks to the T8, T9, T10, and T11 areas. He believes we should submit 64421 four times because of the four injections. Is that correct?

Oregon Subscriber

Answer: Your physician has recommended inaccurate coding. The descriptor for 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional block) states the code represents "multiple, regional block." Because of that, you should report 64421 only once for the injections performed since they're all in the same spinal region (thoracic).

Plus: The other spinal regions don't include intercostal nerves. Code 64421 and its companion code 64420 (Injection, anesthetic agent; intercostal nerve, single) aren't structured like other nerve injection code sets for single and "each additional" injections. Instead, you have one code for injection to a single nerve and one code for multiple nerves. Both codes should be reported with a maximum of 1 unit of service.