HELP!! We have a provider who is requesting to bill Medial Branch Nerve Block 64490 and Lidocaine injection J3490. Can the Lidocaine be billed separately?
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Tag Archives: block
Right C2, C3 MBB and RiGHT TON Block
Hello,
Could I get opinion on how to code this? I feel it is 64490-RT C-2 but it has been questioned on if correct or not.
Would you code it as 64490-RT C-2…or 64490-RT-22 C-2… or 64490-RT C-2 AND 64450-RT TON?
Thank you!
After obtaining written consent, the patient was taken back to the fluoroscopy suite and placed in a prone position on the fluoroscopy table. The skin overlying the cervical spine area was prepped and draped in an aseptic fashion. The C2 transverse process, C3 transverse processes on the right were visualized under AP and slight oblique fluoroscopy. The skin and subcutaneous tissue overlying the target sites of injection were anesthetized using 0.25 ml of 1% lidocaine with a 25-gauge, 1-1/2 inch needle. (one needle used here)
A 25-gauge, 3-1/2-inch spinal needle with a bent tip was advanced under fluoroscopic guidance using a superior to inferior and lateral to medial approach to the scalloped edge of each of the transverse processes as well as the inferior lateral portion of the C2 vertebrae. (one needle here…right?) I do not see that multiple injections with multiple needles were used. One injection with needle to different areas…
The needles were then directed ventral, medial, and caudad to reach the target locations. After negative aspiration for heme or CSF, 0.25 ml of Magnavisc dye was injected at each site under live fluoroscopy, demonstrating absence of vascular uptake. After negative aspiration for heme or CSF, 0.5 ml of 0.25% bupivicaine was slowly injected at each site to avoid forcing the solution away from the target points. The needles were then removed. Sterile bandages were placed over injection sites.
Ganglion Impar Block with Fluoroscopy
Good afternoon,
Can someone please advise on the correct code for Ganglion Impar Block with Fluoroscopy.
Thank you.
Genicular Nerve Block – CPT 64450
This injection is a little confusing for me, I know it’s per nerve or branch. But I keep getting a little stuck on this one. My doctors note reads: I identified the right lateral superior genicular nerve branch at the junction of the lateral femoral shaft and lateral condyle; the right medial superior genicular nerve branch, at the junction of the medial femoral shaft and medial condyle; and the right medial inferior genicular branch, at the junction of the medial tibial shaft and condyle. Local anesthetic administration was performed using 2mL of lidocaine 1% at each location. Then using a 22-gauge spinal needle was directed to each end point identified above, confirming proper positioning under fluoroscopy in AP view. After negative aspiration, we injected consisting of 1.5mL of 0.25% bupivicaine and 10mg of Depo-Medrol and each branch of the genicular nerve.
I know 64450 is usually 1 UOS since it’s per nerve or branch My doctor wants to bill 3 UOS.
Any input would be helpful.
Cell Block Performed On Pap
If the remaining fluid from the pap vial is centrifuged and a cell block prepared and interpreted can we bill an 88305?The pap was originally interpreted by a pathologist and an 88141 coded and billed. Then at a later date the cell block was prepared. There was also an IHC stain done on the cell block.
US Guided Block with 29826
I work at an acute care facility. Is it possible to charge 76942-TC with 29826 OR is this a bundled procedure and included in the charge for 29826 technical component. From what I can find in my research it is included in the charge for the 29826 facility CPT. However, a question has come up in meetings that the 76942 should be a separate charge with a TC modifier. Any assistance is appreciated and any reference documentation please provide……Thanks in advance for your assistance.
Genicular block vs. RFA # of injection to bill for
Hi all,
I have a PAIN physician that is questioning how many injections can be billed for the genicular nerve block (64450) and the RFA (64640).
She is injecting 3 times for both the blocks and RFA’s
I have found CPT Assistant references for both and for the 64450 it states to bill once and for the 64640 it states that 3 can be billed. I know that she will question why the references are different when it is the same nerves being treated for both procedures.
Does anyone have any guidance on this?
I have a PAIN physician that is questioning how many injections can be billed for the genicular nerve block (64450) and the RFA (64640).
She is injecting 3 times for both the blocks and RFA’s
I have found CPT Assistant references for both and for the 64450 it states to bill once and for the 64640 it states that 3 can be billed. I know that she will question why the references are different when it is the same nerves being treated for both procedures.
Does anyone have any guidance on this?
Block:
CPT Assistant, November 2015 Page: 11 Category: Frequently Asked Questions
Question:
When a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, is code 64450 reported three times or just once for the left genicular nerve?
Answer:
It is appropriate to report code 64450, Injection, anesthetic agent; other peripheral nerve or branch, for the genicular nerve block of three branches of this nerve around the knee joint; however, code 64450 is reported just once during a session when performing the injection(s). Although one, two, or more injections may be required during the session, the code is reported only once, irrespective of the number of injections needed to block this nerve and its branches.
For the RFA:
The January 2018 CPT Assistant issue included this Q&A:
Question: What code(s) is used to report an injection on the superior medial and lateral branches and the inferior medial branch of the left genicu-lar nerve performed for destruction with a neurolytic agent?
Answer: Code 64640, Destruction by neurolytic agent; other peripheral nerve or branch, may be reported for each nerve destruction. Therefore, if destruction is performed on the superior medial and lateral branches and the inferior medial branch of the left genicular nerve, it would be appropriate to report code 64640 three times or report code 64640 once with three units of service based on payer preference. The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings of code 64640 to separately identify these procedures.
ASC – Post Op Nerve Block billing
We have been billing separately nerve blocks for surgical procedures using the following guidelines:
1. Separate procedure from surgery
2. separate area then surgery
3. done by a different physician
4. different specialty fro the surgeon
5. separate procedure note
6. separate anesthesia from surgery
7. billed on separate claim form
8. add modifier 59 and list ICD-10 G89.18 first for DX codes
I am not getting push back from our coding company stating that it is CCI edits and you cannot unbundle or bill separately.
Even though AMA guidelines and ASA state you can unbundle and bill just not to Medicare.
Thought – comments
Third Occipital Nerve Block and Ablations
I’m just curious how many people have had issues with providers and TON(third occipital nerve) blocks/ablations.
I’ve found lots of documentation to support using 64490/64633 for the blocks and ablations that take place between the c2-c3 spine. My providers want to use the peripheral codes 64450/64640 – I’m basically at a stand off with my providers at this point, understanding their point but not feeling comfortable changing my coding based solely on their demands, it’s creating an issue.
Any help or resources would be helpful!
Thank you!
hematoma block
Can a hematoma block be billed for the manipulation of a fracture if fracture care is NOT being billed? If so, what would be the appropriate CPT code to report it?
Scenario:
Dr sees a patient with a displaced fracture of neck right fifth metacarpal fracture. He administers a hematoma block and reduces the fracture. He’s not happy with the alignment after a post reduction x-ray is performed . He does not bill for fracture care because he is most likely a surgical candidate so he sends the patient to a hand specialist. Hand specialist books him for surgery.
Scenario:
Dr sees a patient with a displaced fracture of neck right fifth metacarpal fracture. He administers a hematoma block and reduces the fracture. He’s not happy with the alignment after a post reduction x-ray is performed . He does not bill for fracture care because he is most likely a surgical candidate so he sends the patient to a hand specialist. Hand specialist books him for surgery.
Thank you