Outpatient Facility Coding Alert

Question: The provider administered 2 ml of lidocaine 1% at the following locations: “the right lateral superior genicular nerve branch at the junction of the lateral femoral shaft and lateral condyle; the right medial superior genicular nerve branch at the junction of the medial femoral shaft and medial condyle, and the right medial inferior genicular branch, at the junction of the medial tibial shaft and condyle.” What codes should I bill for these services?

Florida Subscriber

Answer: Each of the three listed nerve branches fall under the same peripheral nerve branch injection code, 64450 (Injection, anesthetic agent; other peripheral nerve or branch). While you may consider submitting this code as three separate line items or with 3 units of service (UOS), you would be violating National Correct Coding Initiative (NCCI) policy.

Chapter 8 of the NCCI Policy Manual states the following:

• “CPT^® codes 64400-64530 describe injection of anesthetic agent for diagnostic or therapeutic purposes, the codes being distinguished from one another by the named nerve and whether a single or continuous infusion by catheter is utilized. All injections into the nerve including branches described (named) by the code descriptor at a single patient encounter constitute a single unit of service.”

Additionally, NCCI includes the following example, similar to the example above:

• “If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT^® code 64450 may be reported regardless of the number of injections needed to block this nerve and its branches.”

Therefore, the services rendered only warrant submission of 64450 with one UOS. Any additional code submissions, with or without modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional), will result in a denial by the payer. 

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