Anesthesia Coding Alert

Question: How should I code a lateral cutaneous femoral nerve block? The physician noted 64450 on the superbill, but I wonder if 64447 is a better choice.

Wyoming Subscriber

Answer: Code 64447 (Injection, anesthetic agent; femoral nerve, single) specifically represents an injection to the femoral nerve -- not the lateral cutaneous femoral nerve. Because of this distinction, your physician is correct: 64450 (Injection, anesthetic agent; other peripheral nerve or branch) is the accurate code to report for a lateral femoral cutaneous nerve injection.

Although the lateral cutaneous femoral nerve includes the word "femoral" in its name, it is not the same as the femoral nerve. The lateral cutaneous femoral nerve is a purely sensory nerve that originates from the L2 and L3 spinal nerves and provides innervation to the skin of the lateral thigh.

The femoral nerve contains both motor and sensory fibers and originates from the L2, L3 and L4 spinal nerves. This mixed nerve provides sensory innervation to the front of the thigh and lower leg but also provides motor innervation to the large quadriceps muscles.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.;and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.