Neurology & Pain Management Coding Alert

Question: Our neurologist often uses the diagnosis greater occipital neuralgia, but I can find no mention of this in ICD-9. Which code applies?

California Subscriber  
Answer: The most commonly accepted ICD-9 code for greater occipital neuralgia is 729.2 (neuralgia, neuritis, and radiculitis, unspecified). Be cautious, however, because  the correct diagnosis may be tendonitis (726.90, enthesopathy of unspecified site). Injection of the tendon would be reported 20550 (injection, tendon sheath, ligament, trigger points or ganglion cyst). Use 64405 (injection, anesthetic agent; greater occipital nerve) for an occipital nerve block, with modifier -50 (bilateral procedure) appended if the injection is performed on both sides. 
 
Note: Occipital neuralgia is more of a symptom and usually occurs with an underlying condition. If so, code the underlying condition or a more definitive diagnosis if it is known.
 
 -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandreop, OTR, CPC, CCS-P, CPC-H, consultant-owner and trainer for A+ Medical Management and Education in Egg Harbor City, N.J.