Anesthesia Coding Alert

Question: Several carriers deny our claims for greater occipital nerve blocks with 64405. How should we handle these claims?

Idaho Subscriber

      Answer: You're submitting correctly with 64405 (Injection, anesthetic agent; greater occipital nerve) for a greater occipital nerve (GON) injection, but that doesn't mean every carrier recognizes the service as a covered benefit.

      Some carriers consider the GON injection to be investigational or experimental. Others might cover the injection but limit the diagnoses that support medical necessity. For example, the Trailblazer and Noridian LCDs  for GON injections don't include a specific list of diagnosis codes. First Coast LCD for Florida, on the other hand, has a limited number of ICD-9 codes that establish medical necessity. The First Coast LCD includes 784.0 (Headache) and 723.8 (Occipital neuralgia) as two allowable diagnoses.

            Bilateral watch point: Code 64405 carries a "0" bilateral status indicator in the Medicare Physician Fee Schedule. This means you cannot report 64450 with modifier 50 (Bilateral procedure) or the RT (Right side) and LT (Left side) modifiers. Medicare and most commercial payers will not process a GON injection as a bilateral service.