Neurology & Pain Management Coding Alert

Question: How should I code nerve blocks to the median, ulnar, radial sensory, posterior tibial and sural nerves? Our physician performed the blocks prior to administering Botox injections to the axillae, palm, and sole of a foot.

Louisiana Subscriber
 

Answer: Determine how you would answer this question before turning to page 47 for the answer. Answer: Most carriers typically cover these injections under 64450 (Injection, anesthetic agent; other peripheral nerve or branch). Insurers might question the medical necessity of the pre-injection anesthesia, so be prepared to submit documentation supporting the service (such as information documenting that multiple Botox injections to the palm of the hand and sole of the foot are very painful).

NCCI note: National Correct Coding Initiative edits bundle 64450 as a component of the more comprehensive codes 64650 (Chemodenervation of eccrine glands; both axillae), 64653 (- other area[s] [e.g., scalp, face, neck], per day) and others. Many payers consider the Botox injections part of the chemodenervation injection procedure rather than separately reimbursable.

Bottom line: Verify your carrier's policy before submitting your claim so you can report both parts of the procedure correctly.