Neurology & Pain Management Coding Alert

Tackle correct 64400 and 64405 coding head-on to ensure payment. If your neurology practice is looking to add bilateral occipital or trigeminal nerve blocks as a headache-relief service to your patients, there are a few landmines to sidestep to ensure proper coding and reimbursement. Take a look at what doctors and coders are doing to bring relief to patients and payment to the practice. Step 1: Know the Block's Purpose and Location For bilateral occipital or trigeminal nerve blocks, you-ll be using codes 64405 (Injection, anesthetic agent; greater occipital nerve) or 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch). Occipital: The greater occipital nerve originates from the C2 spinal nerve and provides sensory innervation to the posterior area of the scalp extending to the top of the head. Physicians typically inject the greater occipital nerve (GON) just above the base of the skull for occipital or cervicogenic headaches or neck pain. 64405: "We usually report the code for occipital nerve block in patients with a condition known as occipital neuralgia," says Wayne Sida, MD. This is a painful condition that produces an aching, burning, or throbbing type of pain, tingling, and sometimes numbness on the back of the head -- in the distribution of the greater occipital nerve. A nerve block can be either diagnostic, therapeutic, or both, Sida says. Physicians also have used occipital nerve blocks to treat certain types of headache including cluster headaches. Trigeminal: In contrast, the trigeminal nerve -- also known as cranial nerve V or the fifth cranial nerve -- provides sensory innervation to most of the face. The "trigeminal" name is derived from the fact that the cranial nerve has three major divisions or branches. The ophthalmic nerve, or V1 division, primarily provides sensory innervation to the forehead and eye area. The maxillary nerve, or V2 division, provides sensory innervation to the upper jaw area from below the eye to the upper lip. The mandibular nerve, or V3 division, provides both sensory and motor innervation to the lower jaw area of the face. Trigeminal injections can be performed at any of the three divisions or branches of the divisions and can be used for cluster, tension, or migraine-headaches or atypical facial pain, says Debbie Farmer, CPC ACS-AN, with Auditing for Compliance and Education in Leawood, Kan. 64400: Providers may use different terms than "tri-geminal" when noting the branch being injected, which could confuse coders, Farmer says; she recommends coders use an anatomy book to help. Use 64400 for injections to any of the three divisions or more distal branches including the supraorbital, the infraorbital,and the auriculotemporal nerve. The trigeminal nerve block is used much less frequently, Sida says. "I have used this [...]