Wiki PENG-Nerve block what is correct code for 2024? 64999 or 64447/64450

[ABorchardt]

I am having trouble with an insurance company (Medicare Advantage Plan) not wanting to pay us for a PENG post op nerve block performed for a THA revision surgery June 2024. We billed CPT 64999 for the PENG block performed by our physician. They are using Encoderpro and 2022 reference material that instructs to use CPT 64450 or 64447. I thought per CPT assistant 2023 and a Coding Symposium attended fall 2023, we are to use the unlisted code 64999. We have sent in our records to them and they say no, change it to these codes which I feel is incorrect. Can anyone help me with this?

 

[LisaAlonso23]

PENG = 64999 If performed by anesthesia provider. If performed by surgeon, it's not separately billable.

64999, when performed by an anesthesia provider for post-op pain management, should be billed with 59, LT or RT.
If ultrasound is used, bill 76942-26.

In 2025, we should be provided with a new CPT code for PENG blocks.

 

[missyah20]

Yep, Lisa is correct per the AMA CPT Assistant May 2024 code 64999 should be reported. However in 2025 you will want to look at 64473 or 64474.

 

[tolbert4]

Has anyone reviewed the new codes for the IPACK and PENG Blocks to determine which one is best for the IPACK?

 

[LisaAlonso23]

Has anyone reviewed the new codes for the IPACK and PENG Blocks to determine which one is best for the IPACK?

Use 64473, 64474 for IPACK or PENG blocks.