Anesthesia Coding Alert

Question: I know that some changes were made to codes 64420 and 64421 for 2020 and that you cannot report 64420 as a bilateral procedure. Our provider’s note states, “Gave a series of injections into the posterior cutaneous rami of the thoracic nerve distribution in the upper back bilaterally using 4 cc of buffered 5% dextrose and 1% lidocaine.” Billing both 64420 and 64421 seems appropriate since the descriptor notes “intercostal nerve, each additional level.” Would that be correct?

Pennsylvania Subscriber

Answer: You are correct that CPT^® 2020 introduced changes to codes 64420 (Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level) and +64421 (… intercostal nerve, each additional level (List separately in addition to code for primary procedure)) by including “and/or steroid” in the descriptors. You are also correct that modifier 50 (Bilateral procedure) is not allowed with 64420. However, you can report 64420 with both modifiers LT (Left side) and RT (Right side) to designate bilaterality.

Take note: The 2020 CPT^® update changed +64421 to an add-on code to 64420. Coders are now instructed to report 64420 for the first level and +64421 for each additional level injected. You should only include +64421 when the provider administers an injection to a separate thoracic level.