Neurology & Pain Management Coding Alert

Hint: Home in on individual procedure steps to narrow options With three occipital nerves in the body that your neurologist can treat to alleviate head and neck pain and many nerve injection codes to choose from in CPT, getting confused is easy when coding for third occipital nerve blocks. But you can code the procedures correctly once you have a good understanding of the procedure and the nerves involved. Knowing Anatomy Can Help You Code Correctly When your neurologist indicates that he performed an occipital nerve block, you may assume the procedure is 64405 (Injection, anesthetic agent; greater occipital nerve). But that's not always the case, says Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver. Physicians often administer injections to the third occipital nerve to help diagnose and differentiate forms and causes of headache and neck pain. Depending on what medications your physician uses, these injections can also be therapeutic, rather than just diagnostic, and used to relieve chronic headache and/or neck pain.

-The -third occipital nerve- is not anatomically synonymous with the -greater occipital nerve,-- Hammer says. -Physicians use both injections to diagnose and/or treat some forms of headache. But coding depends more on the anatomical structure and the needle insertion location than the patient's symptoms or diagnosis.-

Clarify sets: There are three separate and distinct pairs of occipital nerves in the body: the greater occipital, the lesser occipital, and the third occipital nerve (also occasionally referred to as the least occipital nerve). By reviewing your physician's documentation, you can identify which nerve he injected and assign the correct code for the procedure:

- The greater occipital nerve (GON) originates between the C1 and C2 vertebrae from the dorsal ramus/branch of the C2 spinal nerve. It primarily provides sensory cutaneous innervation to the scalp from the back of the skull to as far forward as the top of the skull. The GON also has some movement (motor) functions that innervate in the posterior neck muscles and sensory functions for the skin of the posterior scalp.

Physicians often inject the GON to diagnose and treat occipital neuralgia (723.8, Other syndromes affecting cervical region). The practitioner frequently performs the block in an office setting without the assistance of radiologic guidance. You should code it as 64405.

- The lesser occipital nerve (LON) also originates from the C2 spinal nerve, but its source is the ventral ramus/branch. It only has sensory functions that primarily innervate the skin behind the ear. Again, the provider usually administers this block in an office setting without radiologic assistance. CPT does not have a code specifically for the LON injection, so report it with 64450 (Injection, anesthetic agent; other peripheral nerve or branch). [...]