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Old 04-05-2010, 01:59 PM
vanessa10 vanessa10 is offline
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Angry Popliteal and saphenous nerve blocks

I have a chart where the Dr is doing a single popliteal nerve block and a saphenous nerve block. the coder that codes this site is telliing me that both codes get 64450. I do not agree. Can someone tell me where i can find something in writing saying this is incorrect and showing the correct codes to use??
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Old 04-05-2010, 02:31 PM
dsmith1979 dsmith1979 is offline
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http://www.usra.ca/sb_sciaticpopliteal
That website tells you that the popliteal region is the sciatic nerve.
For the poplital block we use 64445 and for the saphenous block we use 64450.
I hope this helps!
Denise
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Old 04-05-2010, 02:38 PM
vanessa10 vanessa10 is offline
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one of my other co workers is telling me to use 64447 for the saphenous block. Does anyone know anything about that?
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Old 04-05-2010, 02:50 PM
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cmcgarry cmcgarry is offline
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The saphenous nerve is a deep branch of the femoral nerve; therefore, 64447 is correct.
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Old 04-05-2010, 02:50 PM
JBSAX JBSAX is offline
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Default Popliteal and Saphenous Nerve Blocks

I agree with the individual above with the 64445 and 64447 codes. I have experience coding and billing for anesthesia and pain management dealing with post-operative and long-term pain management.
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Old 04-05-2010, 03:27 PM
vanessa10 vanessa10 is offline
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Well thank you to all of you. You have been extreamly helpful!
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Old 04-06-2010, 09:19 AM
dwaldman dwaldman is offline
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The lateral cutaneous nerve is a branch of iliohypogastric nerve but if the doctor blocked the lateral cutaneous nerve you wouldn't billed based on the nerve it branches from. You would bill 64450 not 64425.

http://www.chiro.org/ChiroZine/FULL/...es/mckfig3.jpg

I believe that by blocking femoral and the sciatic nerves you are targeting pain in the top of the thigh and the knee for the femoral. The sides and back of the calves with the sciactic nerves. The inner calves with the saphenous. I was under the impression that if you look at 64447 or 64445 it does not say femoral nerve or sciatic nerve and associating branches. If they say the blocked the femoral nerve or the scaitic nerve then I would use those codes but if they are referring to nerves that are not listed in the code range 64400-64449 then I use 64450. This is my own personal preference of trying to accurately reflect what is in the descriptor of the code.
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Old 04-06-2010, 09:42 AM
dwaldman dwaldman is offline
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per Encoder 64445 reimburses at 71.67 with an RVU of 2.15. 64447 reimburses at 62.21 with an RVU of 1.84, and 64450 reimburses at 62.85 with an RVU of 1.86. For the popiliteal nerve block, if the actual nerve blocked is a branch of the sciatic nerve and if this would be considered an "other pepherial branch" but you are billing 64445, you would be getting higher reimbursement. The question you would want to ask if it does not mention in the descriptor and associating branches like 64400 then are you allowed to bill the major nerve code and get the higher reimbursement.
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Old 04-06-2010, 09:23 PM
marvelh marvelh is offline
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Anatomically there is no popliteal nerve. The sciatic nerve separates just above the popliteal fossa into the common peroneal nerve and the tibial nerve. You need to verify with the physician which specific nerve was injected.

The saphenous nerve, as indicated in another post, is a distal branch of the femoral nerve. The saphenous nerve can be injected at the patient's ankle which would be quite different from a femoral nerve injection in the groin.

Codes are based on the physician work, risk and practice expense associated with performing the service. Injecting the main nerve is much different in terms of physician work and malpractice risk than injecting a distal branch. For example, injecting the medial cutaneous nerve of the leg, a branch of the saphenous nerve which is a branch of the femoral nerve takes less physician work / expertise and carries much less risk than inserting a needle into the patient's groin area which has large arteries, veins and other nerves in close proximity.

With this in mind, the physician should be injecting the specific nerve, i.e. sciatic or femoral and not a distal branch in order to code the injection for that specific nerve. If the distal branch does not have a specific injection code and it is likewise a somatic nerve, then it would be appropriate to code the distal nerve injection with 64450.
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Old 05-21-2010, 01:29 PM
kgurney kgurney is offline
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Default Popliteal and saphenous nerve blocks

What if the provider states they are using the popliteal approach, but they are injecting into the sciatic nerve area just before it branches into the two major components (tibial and common peroneal nerves). Is this 64445 or 64450??
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