Neurology & Pain Management Coding Alert

In treating diabetic neuropathy, your neurologist may administer one of three types of blocks to relieve the patient's pain. Knowing the rationale for the specific treatment can help you navigate CPT's coding options.

Diagnostic blocks help identify the source of the patient's pain and indicate the type of nerve conducting the pain. Code diagnostic nerve blocks carefully -- CPT doesn't include a code specific to this procedure. Because it's a diagnostic procedure, your best option might be 90779 (Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion).

Many coders use 64450 (Injection, anesthetic agent; other peripheral nerve or branch) when a neurologist treats diabetic neuropathy. Carriers may question this because during the procedure the physician injects saline instead of an anesthetic agent.

Therapeutic blocks are used to treat painful conditions that might respond to nerve blocks. Coding for therapeutic blocks creates the opposite problem from coding for diagnostic blocks: You have many coding choices rather than none. To simplify, determine if the neurologist administered a neurolytic or if he performed an injection to a particular site. Coding options include the following:

Prognostic blocks help predict the outcome of long-lasting interventions. Appropriate codes for nerve destruction by a neurolytic agent depend on the type of nerve, treatment site, and injection level. Code somatic nerve destruction using the following:

Report your neurologist's sympathetic nerve neurolytic destruction using 64680 (Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus) or 64681 (- superior hypogastric plexus).

Rhizotomy coding: Use 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) or 64626 (- cervical or thoracic, single level) depending on the injection site.

Carriers might deny claims for multiple physicians using the same diagnosis code for a single patient. Work with any other physician the patient is seeing for other aspects of diabetes care to ensure correct coding for the neurologist's services.

Watch details: When coding for diabetic neuropathy treatment, clarify whether the visit qualifies as a consult or referral, what type of pain the patient has, and what the appropriate diagnosis choices are.