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Digital Nerve Block

Bonnie Posted Fri 17th of May, 2013 12:50:52 PM

How would you code the following:

Digital nerve block performed on the right index finger. Web space approach utilized. Landmarks identified. Skin prepped. Total volume of 5 ml 1% lidocaine and 0.5% Marcaine infiltrated via multiple punctures using 27 gauge needle.

Thank you

SuperCoder Answered Wed 22nd of May, 2013 11:33:06 AM

Based on the codes you list, it sounds as if youre administering a nerve block for pain management (postoperatively). If thats the case, 64450* (injection, anesthetic agent; other peripheral nerve or branch) is not related to the base or code for anesthesia. Report it as 64450*-59 (appending modifier -59 for distinct procedural service) and include an applicable ICD-9 code for pain, such as 729.5 (pain in limb)


CPT’s surgery guidelines list “metacarpal/metatarsal/digital block or topical anesthesia” as one of the services that is “always included in addition to the operation.”

Bonnie Posted Wed 22nd of May, 2013 13:42:41 PM

Hi- this was actually performed in the emergency department and was no post op.

SuperCoder Answered Wed 22nd of May, 2013 21:45:51 PM

Still 64450

For payers following CPT guidelines, this service, code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) can no longer be separately coded when performed as a component of a surgical procedure. In this instance, a digital nerve block is clearly bundled as part of the global surgical package, as outlined in the CPT Introduction to the Surgical section-CPT Surgical Package Definition. Under Medicare's global services package rules, digital nerve blocks have always been bundled when performed as a component of a surgical procedure. Thus, when performing a nerve block for a laceration repair of a finger, only the laceration repair should be coded and not the nerve block.

However, digital nerve blocks performed as a stand-alone procedure and not part of a surgical package, (e.g., for pain control alone) generally remain separately codeable under both Medicare and CPT coding principles.

As a side note, code 64450 can also typically be coded when performing dental nerve blocks.

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