Radiology Coding Alert

Question: How should I code ultrasound-guided nerve blocks? 

Pennsylvania Subscriber

Answer: If your radiologist only provides the ultrasound (US) guidance, your most likely option is 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).
 
Check your documentation to be sure this is the most accurate code for the services provided.
 
Careful: To report US guidance, you need permanent recorded images of the localized site and a documented description of the process.
 
If your radiologist also provides the nerve blocks, look to 64470-64476 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve ...) for paravertebral facet joint or facet joint nerve blocks.
 
Codes 64479-64484 (Injection, anesthetic agent and/or steroid, transforaminal epidural ...) describe transforaminal epidural blocks. Check out 64505-64530 (Injection, anesthetic agent ...) for sympathetic nerve blocks.
 
Note: If the block is done under fluoroscopic guidance, use 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction).
 Report one unit per region -- cervical, thoracic or lumbar.

 -- The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.; and Gary S. Dorfman, MD, FACR, FSIR.