Neurology & Pain Management Coding Alert

Question: How should I code nerve blocks to the median, ulnar, radial sensory, posterior tibial and sural nerves? Our physician performed the blocks prior to administering Botox injections to the axillae, palm and sole of a foot.

Louisiana Subscriber

Answer: You should typically report injections of anesthetic agents to these particular nerves with 64450 (Injection, anesthetic agent; other peripheral nerve or branch). But carriers might consider the injection(s) to be part of the surgical global package definition of anesthesia for a surgical procedure.

CCI note: Correct Coding Initiative (CCI) edits, version 13.1, bundle 64450 as a column 2 (component) of the column 1 (comprehensive) codes 64650 (Chemodenervation of eccrine glands; both axillae) and 64653 (- other area[s] [e.g., scalp, face, neck], per day). This edit does allow providers to bypass the edit if the physician's services and documentation support that he administered the injection during a different session or to a different site. In most instances, however, physicians do not administer the pre-procedure nerve block at a different site, so you could not report 64450 separately.

Side note: Remember that CPT's parenthetical note directs you to report 64999 (Unlisted procedure, nervous system) for chemodenervation sympathetic injections to the extremities (hands or feet).