I am getting denials for using a 59 modifier in an ASC for a nerve block (64400 & 64450) for post procedural pain management. They are paying on the professional side with the 59 modifier and ICD 10 G89.18. Would it be more appropriate on the ASC side to use a 58 even though it is the same day?

:confused:New at this, I had a coder put in 64405, but I believe this should be 64490, anyone please help understand..:confused:

Third Occipital Nerve Block, Cervical Spine Medial Branch Nerve Block
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Pre-operative diagnosis:
* * ICD-10-CM
1. Occipital neuralgia of right side M54.81
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Post-operative diagnosis: same
Procedure: right Cervical Spine C2-3 Medial Branch Nerve/Third occipital nerve block between C2-3 (facet) under fluoroscopic guidance
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Indications: This patient has a diagnosis of neck pain due to Occipital neuralgia/headache, Cervicogenic headache and cervical spine spondylosis. Informed consent obtained after explaining the procedure and potential complications including local discomfort, infection, headache, temporary or permanent weakness and/or numbness of one or both legs, temporary or permanent paraplegia, heart attack and stroke. All questions were answered.
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Procedure in detail:
Patient was taken to the procedure room and placed in prone position. Time out was performed. Patient’s right lateral neck/cervical spine area was prepped with Chloraprep and draped in a sterile manner.
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Then, lateral fluoroscopy was used to identify and mark the the center of the C2-3 facet joint on the right side. Additionally, the midpoint of the mid-articular pillars at C2-3 on the right were also marked. Then, under lateral fluoroscopic guidance, a 25 G 3.5 inch spinal needle, was advanced to the targeted points corresponding with the locations of the third occipital nerve.
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Then, after negative aspiration for heme and injection of total 1 ml of Omnipaque contrast, Total 1 mL of lidocaine 1% and 40 mg depomedrol was injected at the target point corresponding to the locations of the third occipital nerve.
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Needle was removed and bandaged placed over site of needle insertion.
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Estimated Blood Loss: None
Specimens: None
Disposition: The patient tolerated the procedure without complaint and was transported to the recovery room in stable condition.
Follow-up: The patient will return as scheduled

I have an MD who performs nerve blocks as part of his pain management. Frequently he states he’s doing a "saphenous nerve block". This procedure takes several injections from about mid thigh to the calcaneous. In the past he used CPT code 64450 however since Medicare has stopped paying this code without treatment notes (5/1/17) we’ve had mixed results with submitting the notes with the claims. Oddly, this happens with the same DX codes and very similar treatment notes and the same patients only weeks if not months apart..
At times he appears as if he should be using 64447 femeral nerve block but I’m not finding anything that really describes this procedure. He’ll mention that he’s performing a series of injections along the femeral nerve.
Part of me wonders if the problem isn’t the varied manner in which he describes the procedures.
Has anyone had success billing the 64450 to Medicare with reliable results? As to date I’ve appealed this code 20 times in the past few months and only 10 of those claims have been paid. He’s frustrated as am I but I need some guidance.
Thank you

Hello can anyone help me out please!!!

What is the proper CPT code for :

Supraorbital nerve block

Auriculotemporal nerve block

Greater occipital nerve block-64405

Some sources say 64400 for SONB and ATNB vs 64450

Proper modifier for B/L is 50?