Neurology & Pain Management Coding Alert

Question: How should we code for bilateral greater occipital nerve blocks with 1.5 cc of bupivacaine and 1.5 cc of dexamethasone?

Massachusetts Subscriber

Answer: Start by reporting 64405 (Injection, anesthetic agent; greater occipital nerve) and modifier -50 (Bilateral procedure) for the bilateral injections.

The provider uses bupivicaine as a local anesthetic to decrease the patient's discomfort associated with the steroid injection. Most payers and even the CPT surgical package definition notes that "Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia" is considered to be included in the procedure code, so you won't report it separately. Submit J1094 (Injection, dexamethasone acetate, 1 mg) or J1100 (Injection, dexamethasone sodium phosphate, 1mg) for the dexamethasone. The steroid medication comes in many different strengths, so confirm the product and the total volume your physician injected in order to calculate the number of units of the HCPCS code to bill.