Neurosurgery Coding Alert

Question: Should I use 64421 when my surgeon performs a single injection for a thoracic intercostal nerve block to block multiple intercostal nerves? Or would 64420 be the better choice?

Indiana Subscriber

Answer: According to CPT Assistant, (August 2010), a "single" injection refers to a single nerve block, so you should report code 64420 (Injection, anesthetic agent; intercostal nerve, single). In a situation when the provider places only one needle into the skin and manipulates the needle "up and down to inject into more than one nerve," you may be able to report multiple blocks (64421, Injection, anesthetic agent; intercostal nerves, multiple, regional block), CPT Assistant states. Bear in mind that "blocking multiple intercostal nerves with a single injection is hard to do in most settings."