Anesthesia Coding Alert

Question: Our physician has begun performing several new injections I'm not sure about coding. How should I code for a lesser occipital nerve block and a posterolateral knee injection?


Kentucky Subscriber


Answer: Report the lesser occipital nerve block with 64405 (Injection, anesthetic agent; greater occipital nerve). Some coders recommend 64402 (... facial nerve) instead, but this will depend partly on the physician's technique. For example, some physicians administer these injections to the back of the patient's head, which means 64410 is not accurate.

Report the posterolateral knee injection with 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).

These procedures can be either unilateral or bilateral, so verify how many sides the physician treats. If the injections are bilateral, append a modifier to the appropriate procedure code to designate this. Most carriers prefer modifier -50 (Bilateral procedure), but some prefer -LT (Left side) and -RT (Right side) instead. Check the carrier's policy to follow the correct guidelines. Answers to You Be the Coder and Reader Questions were provided by Robin Fuqua, CPIC, coder for Jose Veliz, MD, Inc., in Escondido, Calif.