Neurology & Pain Management Coding Alert

Tip: Watch for other names that could mean trigeminal.

If your physician administers trigeminal nerve blocks to patients for headache relief, brush up on the ins and outs of anatomy and potential diagnoses before coding. Read on for two keys that will keep your coding for these procedures pain free.

Learn the Location

The trigeminal nerve provides sensory innervations to most of the face; providers might also refer to the trigeminal nerve as the "cranial nerve V" or the "fifth cranial nerve." The name "trigeminal" stems from the fact that the cranial nerve has three major divisions, or branches:

• The ophthalmic nerve (V1 division) primarily innervates the forehead and eye area
• The maxillary nerve (V2 division) provides innervation to the upper jaw area from below the eye to the upper lip
• The mandibular nerve (V3 division) provides both sensory and motor innervation to the lower jaw area.

Providers can administer trigeminal injections at any of the three divisions or branches of the divisions, says Debbie Farmer, CPC, ACS-AN, with Auditing and Compliance Education in Leawood, Kan. You should report injections with 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch).

Patients who need trigeminal nerve injections can have conditions ranging from severe headache to postherpetic neuralgia to trigeminal neuralgia (also known as tic douloureux). Common diagnosis codes can include:

• 053.12 -- Postherpetic trigeminal neuralgia
• 350.1 -- Trigeminal neuralgia
• 350.2 -- Atypical face pain.

Review Bilateral Rules

If your provider administers bilateral injections, include extra details with the claim that will help garner the appropriate reimbursement. Medicare and many other payers allow you to report trigeminal injections bilaterally by appending modifier 50 (Bilateral procedure).

Medicare guideline: Most Medicare contractors request that providers report bilateral services as one line item with modifier 50 appended and one unit of service noted (64400-50 x 1). Medicare will process the service at 150 percent of the allowed amount, which means you'll be reimbursed 100 percent for the first injection and 50 percent for the second contralateral one.

Other payers: Verify guidelines before submitting a bilateral claim for a non-Medicare payer. Some follow Medicare policies and expect you to report the injections as a single line item. Other commercial payers require two line items instead. In that situation, you should list one unit of service on line one with modifier LT (Left side) appended, and one unit of service on line two with modifier RT (Right side) appended.