Neurosurgery Coding Alert

Question: If the physician provides a single injection for a thoracic intercostal nerve block to block multiple intercostal nerves, should you report 64421, (Injection, anesthetic agent; intercostal nerves, multiple, regional block), or is it better to go with 64420 (Injection, anesthetic agent; intercostal nerve, single)?

Answer: "From a CPT coding perspective, 'single injection' means 'single nerve block,'" so you would report code 64420, confirms the November 2010 CPT Assistant. "If only one needle is placed into the skin but manipulated up and down to inject into more than one nerve, it may be possible to report multiple blocks (code 64421)," but "blocking multiple intercostal nerves with a single injection is hard to do in most settings," CPT Assistant notes.