Neurology & Pain Management Coding Alert

Question: Our physician performed radial, median and ulnar nerve blocks on the patient’s right hand using ultrasound guidance. She repositioned the needle after the ulnar nerve injection to inject the median nerve. The diagnosis was neuritis of the radial, median, and ulnar nerves. What are the best codes for the procedure and diagnosis?

New Mexico Subscriber

Answer: It’s difficult to answer your question without knowing whether you say “repositioned” meaning there was a separate needle placement and injection or that the physician “repositioned” the needle under the skin to inject the medication near a median nerve.

Query the provider to verify whether there were three separate needle placements with three separate injections. If the physician clarifies that she performed three separate needle placements and injections, report 64450-RT (Injection, anesthetic agent; other peripheral nerve or branch; Right side) with three units of service.

A single needle placement could only be billed as one injection regardless of the number of nerves blocked. 

Remember: If your physician administered the blocks as an anesthetic for a surgical procedure, the injections would be considered part of the surgery (if performed by the surgeon) or part of the anesthesia (if performed by the anesthesiologist).

You’ll include three diagnosis codes since your physician listed neuritis of three nerves: G56.31 (Lesion of radial nerve, right upper limb), G56.11 (Other lesions of media nerve, right upper limb), and G56.21 (Lesion of ulnar nerve, right upper limb).

Final note: Check your Medicare coverage policies as many MACs have LCD covering 64450 and peripheral neuropathy treatment.