Pain Management Coding Alert

Question: Our physician performed a digital nerve block on the patient’s right index finger for postoperative pain management, utilizing a web space approach. The total volume injected was 5 ml 1% lidocaine and 0.5% Marcaine infiltrated via multiple punctures using a 27 gauge needle. How should we report this service?

Delaware Subscriber 

Answer: Digital nerve blocks performed as a stand-alone procedure and not part of a surgical package generally are separately codeable under both Medicare and CPT® coding principles. That being said, your first step is to confirm the purpose of the injection and whether it was separate from a surgical procedure. 

If your physician administered a nerve block for postoperative pain management, submit 64450 (Injection, anesthetic agent; other peripheral nerve or branch) with modifier 59 (Distinct procedural service). Include the applicable diagnosis code for pain, such as 338.18 (Other acute postoperative pain) if you have supporting documentation. If you don’t have details regarding the postoperative management, a more general code such as 729.5 (Pain in limb) might be the better choice. q