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Diagnostic SI lateral branch blocks

Lori Posted Tue 18th of March, 2014 11:40:06 AM

What codes should be billed for the diagnostic L5 medial branch block and the S1, S2, S3, S4 lateral branch blocks prior to the RFA?

SuperCoder Answered Wed 19th of March, 2014 02:11:07 AM

Physicians use diagnostic nerve blocks to determine sources of the patient's pain. These blocks typically contain an anesthetic with a known duration of relief. Therapeutic nerve blocks contain local anesthetic to control acute pain, once the physician confirms the source and cause of discomfort.

Most CPT section headings for injection or nerve block codes mention "diagnostic or therapeutic." The codes often cover both situations, which means you could possibly report the same code for both diagnostic and therapeutic injections, based on the type of block and administration site.

Example: A provider might inject an anesthetic and a steroid into a facet joint or a peripheral nerve to determine whether that is the source of the patient's pain. In that situation, a nerve block might be both diagnostic and therapeutic.

But payers may want to know whether the block is diagnostic or therapeutic. Specifying such can be a criterion of coverage. Educate your physicians on the importance of documenting whether the patient receives a diagnostic or therapeutic block.

Remember: Check whether you may report radiological guidance separately or whether it's included. For example, you should not report imaging guidance separately with a code such as 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level). The code definition states "with image guidance" and CPT guidelines before the code tell you that fluoroscopy and CT guidance as well as contrast injections are included in 64490.

Lori Posted Wed 19th of March, 2014 11:47:23 AM

But what code should be used for the lateral branch blocks of the S1, S2, S3, S4? 64450 for the branch block and 64640 for the RFA?

SuperCoder Answered Thu 20th of March, 2014 12:32:56 PM

For the 4 lateral branch block injections at S1, S2, S3, and S4, report 4 units of CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch.

CPT® includes several codes for varying specific somatic nerve destruction procedures. Currently there isn't a specific CPT® code for the anterior abdominal cutaneous nerves. However, CPT® does provide 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) for standard radiofrequency of other somatic nerves and/or branches.

Tip: In many cases, the physician first performs an injection of local anesthetic to verify the source of the patient's pain. If the procedure report documents the temporary block, then you can submit 64450 (Injection, anesthetic agent; other peripheral nerve or branch). After determining that the diagnostic block successfully alleviated the patient's pain, the physician may elect to perform a neurolytic destruction during another visit; that's when you'll report 64640.

Lori Posted Thu 20th of March, 2014 16:09:44 PM

Can you charge 64493 for the L5 nerve block?

SuperCoder Answered Thu 20th of March, 2014 16:38:04 PM

Yes, L5 medial branch block - 64493

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