Neurosurgery Coding Alert

Question: My neurosurgeon performed an occipital nerve block for the patient. He diagnosed LON involvement and performed the block for the LON without radiological assistance. Which code should I report for this procedure?

Alabama Subscriber

Answer: Since the surgeon diagnosed LON involvement and performed a block for the LON without radiological assistance, you should report 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch).

However, CPT^® does not assign a specific code for LON block procedure, so, 64450 doesn’t specifically refer to a block of that nerve. “CPT^® includes only a limited number of codes for injecting specific peripheral nerves. If one is not specified, like LON, then code 64450 is applied,” 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.

LON: The lesser occipital nerve begins at the lateral branch of the ventral area of the C2 and C3 spinal nerves. This nerve is tasked with innervating the area of the scalp and head posterior to the ears.

“The lesser occipital nerve is several inches away from the greater occipital nerve so these nerves are not reached through the same injection site,” according to CPT^® Assistant Vol. 26, No. 10. “The lesser occipital nerve is at the side of the head by the ear, whereas the greater occipital nerve is at the very back of the head.”

Surgeons typically perform a LON injection behind the patient’s ear.

Caution: You should not separately report the local anesthesia with an occipital nerve block code. The surgeon will administer local anesthesia into the overlying skin prior to administering the block. This helps to reduce the needle-track pain and ensures the patient is seated comfortably during the procedure.