Neurology & Pain Management Coding Alert

Reader Question:

For Same Region, Keep to Single 64421

Published on Mon Sep 24, 2012

Question: The physician documented that he performed blocks at T8, T9, T10, and T11. He coded 64421 four times, but I'm not sure that's correct. Is it?

Michigan Subscriber

Answer: Unfortunately, your physician recommended incorrect coding for this service; fortunately, you caught it so won't submit an erroneous claim. The descriptor for 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional block) encompasses "multiple, regional block." Because of that, you should report 64421 only once for the injections performed since they're all in the same spinal region (thoracic).

Also note: The other spinal regions don't include intercostal nerves. Code 64421 and its companion code 64420 (Injection, anesthetic agent; intercostal nerve, single) aren't structured like other nerve injection code sets for single and "each additional" injections. Instead, you have one code for injection to a single nerve and one code for multiple nerves. Both codes should be reported with a maximum of 1 unit of service.

Neurology & Pain Management Coding Alert

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