Nancy Posted Fri 21st of January, 2011 13:52:03 PM
My provider did the procedure Left greater occipital nerve block and left lesser occipital nerve block. He states in his report with the use of a 25 gauge 1-1/2 inch needle we introduced the needle along the superior nuchal ridge at the level of the mastoid process and in a fanlike motion injected 10 cc of the premixed solution on a superficial distribution of the Greater and Lesser occipital nerve both on the left side. The CPT codes billed were 64405 for the Greater Occipital nerve and 64450 for the lesser Occipital nerve. The insurance company is denying the CPT ciode 64450 stating it is not the correct code. I was always told that CPT does not have a code specifically for the LON injection, so report it with CPT code 64450. Has something changed? We have sent this to appeals and they are still denying. Any suggestions? Thanks for your help
SuperCoder Answered Fri 21st of January, 2011 21:51:27 PM
The lesser occipital nerve also originates from the C2 spinal nerve, but its source is the ventral ramus. It has only sensory functions that innervate the skin behind the ear. When blocking this nerve, we should report 64450
As of now, the latest information that I have is that some new claim edits are going to implemented around Jan 28, 2011 as follows:
Edit #239 was revised to bundle the injection of anesthetic agents (64405 and 64450) when performing these procedures--injections of tendons (sheath/origins/insertions-20550-20551), injection for carpal tunnel (20526) or for injections of single or multiple trigger point injections, 1-3 muscle groups (20552-20553). NCCI edits, Version 16.3, lists the years that CMS added the bundling of these services.