Anesthesia Coding Alert

Question: I’m having trouble deciding the best code for a SPANK (sensory posterior articular nerve of the knee) block because fellow coders keep giving me different advice. Several of them have recommended 64454, but the descriptor instructs that all three nerves must be injected to report 64454 — and my understanding is that a SPANK block is a single injection technique that blocks multiple nerves. What’s your advice? And if the answer varies, what determines which code is appropriate?

Minnesota Subscriber

Answer: Your experience with conflicting advice for reporting a SPANK block is not unusual. Code 64454 (Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed) is often recommended, as you note, but that is not your most accurate option because of the multiple nerve branches injected. Instead, you should report 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch) with documentation explaining the procedure.

Also: You may want to contact your local third-party payers before submitting 64450 since they might have additional information and requirements for reporting this code.