Revenue Cycle Insider

Question: We recently got denied for billing 64450 with R05.3. Why is this, and what should we be billing instead?

AAPC Forum Participant

Answer: Without more information regarding which nerve your provider blocked to help prevent the patient’s persistent cough, it is hard to assign the correct CPT^® code for the service. However, 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch) is unlikely to be correct, as the code does not specify the nerve targeted for the block.

In all likelihood, for a patient suffering from a persistent, unexplained cough, coded to R05.3 (Chronic cough), your provider would have targeted the vagus nerve. That’s because the superior laryngeal nerve, which branches off from the vagus nerve, provides sensation control to the internal laryngeal nerve, which governs coughing and swallowing reflexes.

So, it would make sense that the correct code for the nerve block would be 64408 (Injection(s), anesthetic agent(s) and/or steroid; vagus nerve). This code is more specific, anatomically speaking. But if that is not the nerve your provider targeted for the block, and no other CPT^® code accurately describes the nerve specified in your provider’s documentation, then 64450 may be appropriate.

Remember: Per CPT^® guidelines, “imaging guidance and localization may be reported separately” for either code. Additionally, you can also bill for the steroid used in the injection using the appropriate HCPCS Level II J code.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC