Genicular Nerve Billing

celcano

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I am confused over the billing of genicular nerve blocks. These are the nerves injected:
Right superior and lateral genicular
Right superior and medial genicular
Right inferior and medial genicular

I have researched this and found two different answers:

1) Bill 64450 X1 (Per CPT Assistant from November 2015 - Question: When a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, is code 64450 reported three times or just once for the left genicular nerve?
Answer: It is appropriate to report code 64450, Injection, anesthetic agent; other peripheral nerve or branch, for the genicular nerve block of three branches of this nerve around the knee joint; however, code 64450 is reported just once during a session when performing the injection(s). Although one, two, or more injections may be required during the session, the code is reported only once, irrespective of the number of injections needed to block this nerve and its branches
OR
2) Bill 64450 X3 (The rational I found behind this is the knee joint is innervated by the articular branches of various nerves, including the femoral, common peroneal, saphenous, tibial, and obturator nerves. These branches around the knee joint are known as genicular nerves. If the provider specifically documents in the record that he has performed injection in different branches, you can use multiple units of code 64450 with modifier 51.

Any guidance as to what is really appropriate to bill for this is greatly appreciated.
 

dwaldman

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If someone is auditing the charge, they could access AMA CPT Assistant and could base their stance on payment on this published source. If you feel the answer the AMA provided needs further review, I would recommend sending them through the AMA CPT Network a follow up question. Is the information that you provided in 2) documented prior to the AMA CPT Assistant information coming out, if so I would go back the author of 2) and state how does the AMA CPT Assistant Q & A effect your guidance.
 
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