ED Coding and Reimbursement Alert

Question: Can I bill for Digital Nerve Blocks? What about dental blocks in the ED setting?

Texas Subscriber

Answer: For payers following CPT^®  guidelines, this service, code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) or any other type of nerve block can no longer be separately coded when performed as a component of a surgical procedure.  In this instance, a digital nerve block is clearly bundled as part of the global surgical package, as outlined in the CPT^® Introduction to the Surgical section - Surgical Package Definition.  Under Medicare’s global services package rules, digital nerve blocks have always been bundled when performed as a component of a surgical procedure.  Thus, when performing a nerve block for a laceration repair of a finger, only the laceration repair should be coded and not the nerve block.

However, digital nerve blocks performed as a stand-alone procedure and not part of a surgical package, (e.g., for pain control alone) generally remain separately reportable under both Medicare and CPT^® coding principles.

Dental blocks are a billable procedure. Code 64450 or 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch) can be coded when performing dental nerve blocks.

The appropriate Evaluation/Management code modified with a 25 modifier may be used in addition to the nerve block code to identify a significant, “separately identifiable” medical service.