Question: My physician performed three bilateral nerve blocks: a lesser occipital nerve block, a greater occipital nerve block, and a supraorbital occipital nerve block. Do these procedures require three separate codes? If so, are they each billable together? Also, can we code for these procedures using a migraine diagnosis? Georgia Subscriber Answer: These three procedures all require individual codes and can be alongside one another. There is some confusion in the coding community when it comes to differentiating between greater and lesser occipital nerve blocks, and additionally how they relate to supraorbital nerve blocks. Let's take a look at these three procedures from an anatomical perspective: When one of these nerves malfunctions, the result is an excruciating pain that the provider typically treats with a nerve block (anesthetization of the nerve). As for coding, we will apply these three nerve block CPT® codes for the great occipital, lesser occipital, and supraorbital nerve blocks, respectively: You will also be appending modifier 50 (Bilateral procedure) to all three procedure codes due to the documentation of bilateral nerve blocks. Correct Coding Initiative (CCI) edits do not report any circumstances in which these three procedures bundle together; therefore, they are appropriate to bill out separately without the use of a differentiating modifier. This last question regarding a migraine diagnosis is where a provider will find trouble, however. A simple local coverage determination (LCD) lookup will reveal that no ICD-10 relating to a migraine is covered for any of these three procedures. If this is the only diagnosis on file, you will need to send the report back to the physician to determine if any additional diagnosis exists that is a covered diagnosis per the Medicare LCD.