Question 64450 Peripheral nerve block

Nancy Klein

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Can someone tell me how they would code this: "Fluoroscopy camera was placed in the anterior-posterior position with cephalad tilt to identify the S1, S2 and S3 sacral foramina. Needles were introduced into the lateral position of S2 and S3 and superolateral position of S1. After negative for aspiration of CSF and blood with no paresthesia and injection of 1 ml block solution of 0.5% pres. free Marcaine all needled were removed....procedure repeated on the other side."

The physician coded 64450.

The insurance company (Medicare Advantage plan) denied siting the LCD L35222 which states cpt 64450 subcutaneous injection do not involve the structure described by cpt 64450, direct injection into other peripheral nerves, but rather in the injection of tissue surrounding a specific focus. This code addresses the addl. work of an injection of anesthetic agent, into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively easily localized areas.

So basically, the insurance company is stating the physician did NOT inject into a peripheral nerve but rather a subcutaneous tissue. Is 64450 correct for this procedure? If no, what would be the correct code?

Thank you in advance!


True Blue
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These are not peripheral nerve blocks - these sound to me like transforaminal epidural injections, so I'd recommend looking at codes 64483-64484.