Neurology & Pain Management Coding Alert

The agent the doc injects can give clues to proper coding When coding injections or infusions of the lumbar spine, you should know two things before you begin: 1. Did the neurologist perform a nerve block or nerve destruction? 2. Which nerve did the neurologist target?

Follow these five tips to help you answer these questions and choose the right code. 1. Blocks Are Temporary For nerve blocks, you can select from many codes in the 64400-64530 range. These procedures relieve back pain by anesthetizing the targeted nerve(s).

The neurologist may provide such services as a therapeutic measure (to increase patient comfort) or as a diagnostic tool (by numbing the nerves, the neurologist can pinpoint the source of the patient's pain and determine the underlying cause).

Common diagnoses supporting medical necessity for diagnostic blocks include 724.4 (Thoracic or lumbosacral neuritis or radiculitis, unspecified), 724.02 (Spinal stenosis, lumbar region), 722.10 (Displacement of lumbar intervertebral disk without myelopathy) and 724.3 (Sciatica).

Important: The purpose of the nerve block (therapeutic or diagnostic) will not affect your coding. That is, you would report a diagnostic nerve block and a therapeutic nerve block of a given nerve using the same code.

Although nerve blocks can provide permanent pain relief, as with reflex sympathetic dystrophy patients, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y., most nerve blocks provide only temporary relief. 2. Destruction Is Forever For nerve destruction, look to the 64600-64681 series of CPT Codes (spinal codes are confined to 64622-64640). Unlike nerve blocks, nerve destruction - also known as denervation - permanently "kills" the nerve.

Nerve destruction is often one of the physician's last resorts for pain management after other techniques have failed, says Barbara Johnson, CPC, MPC, owner of Real Code Inc., a consulting firm in Moreno Valley, Calif.

"Most physicians would not perform neurolysis for trivial pain," Groudine says. "Once alcohol is put on a nerve, that nerve may never function again. Most people use it when the risk/benefit ratio favors extreme measures."

Conditions that may justify nerve destruction can include facet-mediated pain (724.8, Other symptoms referable to back), certain types of degenerative disk disease (from the 722.x series for Intervertebral disk disorders) and small herniated disk (such as spondylosis [721.3] or postlaminectomy syndrome [722.83] without radicular component or pain).

Continuous Infusion Is an Option Keep in mind that nerve blocks can occur either by single injection or continuous infusion by catheter. The distinction matters when choosing the appropriate code(s).

Example: The neurologist provides a single [...]