ED Coding and Reimbursement Alert

Question: The ED physician performed a diagnostic nerve block on a patient complaining of pain in the floor of her mouth and her bottom set of teeth. We coded 64402 for the encounter, but the claim was rejected. Why didn't we get paid for this claim?


South Carolina Subscriber

 
Answer: You chose the incorrect nerve block code for this scenario. You should use 64402 (Injection, anesthetic agent; facial nerve) for facial nerve blocks, not blocks in the mouth or jaw. Your surgeon treated a branch of the trigeminal nerve, not the facial nerve.

On the claim, report 64400 (... trigeminal nerve, any division or branch) for the nerve block.

Other 64400 scenarios: Areas affected by the trigeminal nerve and its branches, and therefore coded with 64400 for nerve blocks, include:

- the body of the mandible and the lower portion of the ramus

- upper and lower teeth

- floor of the mouth

- anterior two-thirds of the tongue

- gingiva on the lingual surface of the mandible

- gingiva on the labial surface of the mandible

- mucosa and skin of the lower lip and chin.