Hi! My provider and I disagree with the proper codes for migraine/nerve block injections. One of us believes 64615 covers all of the below. The other thinks that there is money that could be left on the table. Could someone help settle this so we can properly code these charts, please? Below is one of the notes in a patient's chart.
The patient was placed in a sitting position with the head in a neutral position. I injected the right supratrochlear nerve after aspiration (confirmed, no blood flashback) with 0.25cc of bupivacaine 0.75% (total 0.25cc) with a 30 gauge needle and proceeded to inject the supraorbital nerve after aspiration (confirmed, no blood flashback) with 0.25 cc of bupivacaine 0.75% bilaterally with a 30 gauge needle (total .5cc).
With the patient in a sitting position, I injected the right auriculotemporal nerve after aspiration (confirmed, no blood flashback) with 1 cc of bupivacaine 0.75% with a 30 gauge needle (total of 1cc). I then injected the right temporalis region after aspiration (confirmed, no blood flashback) with 1 cc of bupivacaine 0.75% in 3 separate sites bilaterally with a 30 gauge needle (total of 1cc).
With the patient in a sitting position. I injected the lesser occipital nerves after aspiration (confirmed, no blood flashback) bilaterally with 1cc of bupivacaine 0.75% mixed with decadron with a 27 gauge needle (total of 4 cc). I proceeded to inject the greater occipital nerves after aspiration (confirmed, no blood flashback) bilaterally with 3cc of bupivacaine 0.75% (total 6 cc).
With the patient in a lateral position, I injected the cervical paraspinal muscles bilaterally in 3 different sites after aspiration (confirmed, no blood flashback) with 1cc of bupivacaine 0.75% (total 2cc). I proceeded to place the patient in a sitting position and injected the bilaterally trapezius muscles after aspiration (confirmed, no blood flashback) with 1cc of bupivacaine 0.75% (total 2 cc).
The patient was placed in a sitting position with the head in a neutral position. I injected the right supratrochlear nerve after aspiration (confirmed, no blood flashback) with 0.25cc of bupivacaine 0.75% (total 0.25cc) with a 30 gauge needle and proceeded to inject the supraorbital nerve after aspiration (confirmed, no blood flashback) with 0.25 cc of bupivacaine 0.75% bilaterally with a 30 gauge needle (total .5cc).
With the patient in a sitting position, I injected the right auriculotemporal nerve after aspiration (confirmed, no blood flashback) with 1 cc of bupivacaine 0.75% with a 30 gauge needle (total of 1cc). I then injected the right temporalis region after aspiration (confirmed, no blood flashback) with 1 cc of bupivacaine 0.75% in 3 separate sites bilaterally with a 30 gauge needle (total of 1cc).
With the patient in a sitting position. I injected the lesser occipital nerves after aspiration (confirmed, no blood flashback) bilaterally with 1cc of bupivacaine 0.75% mixed with decadron with a 27 gauge needle (total of 4 cc). I proceeded to inject the greater occipital nerves after aspiration (confirmed, no blood flashback) bilaterally with 3cc of bupivacaine 0.75% (total 6 cc).
With the patient in a lateral position, I injected the cervical paraspinal muscles bilaterally in 3 different sites after aspiration (confirmed, no blood flashback) with 1cc of bupivacaine 0.75% (total 2cc). I proceeded to place the patient in a sitting position and injected the bilaterally trapezius muscles after aspiration (confirmed, no blood flashback) with 1cc of bupivacaine 0.75% (total 2 cc).