Neurosurgery Coding Alert

Remember: Never report 64416 in conjunction with 01996.

In 2020, CPT^® will bring you numerous revisions and additions to the “Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic” section. Not only should you stay up to date on the code changes, but you should also be aware of the new and revised accompanying guidelines for these codes.

Read on to make sure you always submit clean injection claims in your neurosurgery practice.

Catch Guidelines for New and Revised Codes

Revised codes: When you look in the “Somatic Nerve” section, you will see that CPT^® has revised eighteen codes. They are as follows:

• 64400 (Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular)) through 64416 (… brachial plexus, continuous infusion by catheter (including catheter placement). Note: You should never report 64416 in conjunction with 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration)
• 64417 (… axillary nerve) through 64420 (… intercostal nerve, single level)
• +64421 (… intercostal nerve, each additional level (List separately in addition to code for primary procedure)) through 64445 (… sciatic nerve). Note: You should use +64421 in conjunction with 64420.
• 64446 (… sciatic nerve, continuous infusion by catheter (including catheter placement)) through 64450 (… other peripheral nerve or branch) Note: You should never report codes 64446-64449 in conjunction with 01996.

“Codes 64400-64489 (Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed)) describe the introduction/injection of an anesthetic agent and/or steroid into the somatic nervous system for diagnostic or therapeutic purposes,” according to the 2020 CPT^® guidelines.

New codes: You’ll also gain two new codes in this same section:

• 64451 (Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)). Note: Never report 64451 in conjunction with injection, diagnostic or therapeutic agent codes 64493-+64495, fluoroscopic guidance codes +77002 and +77003, CT code 77012, or guidance for chemodenervation codes+95873 and +95874.
• 64454 (… genicular nerve branches, including imaging guidance, when performed). Note: Never report 64454 in conjunction with new destruction by neurolytic agent code 64624. Also, if you report 64454, check the documentation to make sure that the surgeon injected the superolateral, superomedial, and inferomedial genicular nerve branches. If the surgeon does not inject all three of these nerve branches, then you must append modifier 52 (Reduced services) to 64454.

Don’t miss: When the surgeon performs a 64400-64450 and 64454 service, he injects an anesthetic agent(s) and/or steroid into a nerve plexus, nerve, or branch, per the guidelines. You should report these codes only once per nerve plexus, nerve, or branch, as their descriptor describes, no matter the number of injections the surgeon performs along the nerve plexus, nerve, or branch.

Observe Imaging Guidance and Localization Instructions

CPT^® 2020 also specifies how you should report imaging guidance and localization with these new codes.

You can separately report imaging guidance and localization for 64400-64450.

On the other hand, imaging guidance and injection of contrast are included in codes 64451 and 64454, so you cannot separately report these procedures.

“It is important to keep track of which codes include and do not include image guidance,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “Historically, image guidance has been separately reportable with many percutaneous procedures. However, a number of years ago, CPT^® began to develop new and revised codes that included image guidance when it was either required or typically done to perform the procedure. As a result, codes that have not been revised may still allow separate reporting for image guidance whereas new and revised codes typically have guidance included.”

Don’t miss: CPT^® also added new guidelines regarding imaging guidance and localization for already existing codes in this same section.

Imaging guidance and any injection of contrast are included in paravertebral block (PVB) codes 64461-64463 and transversus abdominis plane (TAP) block codes 64486-64489, so you should not report these services separately.

Additionally, imaging guidance (fluoroscopy or CT) and any injection of contrast are included in injection codes 64479, +64480, 64483, and +64484, so you should not report these services separately.

However, you may separately report imaging guidance (ultrasound, fluoroscopy, or CT) and localization with 64455 (Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma).

Putting It All Together

Example: The neurosurgeon injects an anesthetic agent into the nerves innervating the patient’s sacroiliac joint. The neurosurgeon injects five nerves. The neurosurgeon uses CT guidance to perform this procedure.

Solution: You will report 64451 for this procedure.
Don’t miss: With 64451, you should report one unit for any number of nerves innervating the sacroiliac joint inject, regardless of the number of injections.

Also, since imaging guidance is included is an inclusive component of 64451, you cannot report the CT guidance separately.