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64450 x 2

Blackhorse Posted Tue 15th of October, 2019 17:59:14 PM
Procedure note: A linear transducer and ultrasound were used for visualization of several brances of the femoral cutaneous nerve and inferior saphenous nerve on the medial aspect of the knee. Two different nerves were identified (one proximal and one distal to the knee). A 22 gauge, 1.5 inch needle was advanced to the area of the peripheral nerve tendon sheath where he was injected with a large volume of a diluted lidocaine mixture proximal to the knee. He then stood up and performed several squats....We opted to treat the second nerve of the medial branch of the inferior saphenous nerve in the same fashion...Doctor wants to bill 64450x2, but the saphenous nerve is part of the femoral nerve, can he bill 64450 twice? If he can, what Dx code we can use with Medicare Noridian?
SuperCoder Answered Wed 16th of October, 2019 04:41:13 AM



CPT code 64447 should be used for injection of anesthetic agent in femoral nerve and its branches. Therefore, it would be appropriate to bill CPT code 64447 for femoral nerve bock and its branch (saphenous nerve block).


However, some payers may prefer CPT code 64450 for saphenous nerve block.


Kindly refer to your payer to identify the rules, regulations and guidelines specific to billing for pain management codes and bill accordingly.



Blackhorse Posted Wed 16th of October, 2019 12:42:52 PM
This is Medicare California (Noridian), can we bill 64447 x 2?
SuperCoder Answered Thu 17th of October, 2019 04:05:55 AM



MUE of CPT code 64447 is “1” which means this code can be billed for only one unit for a date of service. However, MAI of this code is “3” which means MACs may pay excess units upon appeal or may bypass the MUE based on documentation of medical necessity. If your documentation is strong enough to suggest the payer (Noradian) the medical necessity of the procedures performed, your claim with two units would get paid.


Hope provided information would be helpful.



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