Genicular Nerve Block 64450

tatumroe

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I need clarification from someone in the pain management world. My provider is performing a genicular nerve blocks where he indicates he injected the superior medial and lateral epicondyles of the femur as well as the distal aspects of the medial tibial epicondyle. I have read that CPT 64450 is per nerve or branch not per injection. Per my physician he gave the injections into different branches of the femoral nerve. How would I code this? 64450 only once? 64450 with 3 units? 64450 on multiple lines with -51 modifier? Any help is appreciated.
 
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Per Medicare's NCCI Edits:

"(2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches."

Melissa Harris, CPC
Albany Saratoga Centers for Pain Management
ACE, Inc
 

tatumroe

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Thank you. I thought that I was understanding that correctly but then when he stated he was doing 3 different branches of the same nerve I became confused because I found that the code is per nerve or branch. This is from one of his notes, so he would only get credit for one unit of 64450:
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PROCEDURE DESCRIPTION:
The patient was taken to the procedure room, where a time out was conducted using the following parameters: correct patient, correct procedure, correct side, and allergies. Thereafter, the patient was positioned in the supine position on the fluoroscopy table. Blood pressure and pulse oximetry monitors were placed allowing the patient to be monitored throughout the entirety of the procedure.
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The patient's knee was then placed on pillows as tolerated to offset a clear lateral view of each leg. The skin of the target knee was prepped and draped in the usual sterile fashion using ChloraPrep and sterile towels. Under fluoroscopy, the superior medial and lateral epicondyles of the femur, as well as, the distal aspect of the medial tibial epicondyle of the affected knee, were identified as the target zones for the injections, using an AP view. Each region was marked and the overly skin and subcutaneous tissues were infiltrated with a total of 3 mls of 1% Lidocaine. Using 3.5-inch, 22 gauge spinal needles, each target was approached and advanced using fluoroscopic guidance until reaching the midlevel of the femur and tibia. Needle tip positioning was confirmed using lateral fluoroscopic views and injecting 0.5 mls of contrast at each target site after aspiration was negative for air and heme.
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After a second negative aspiration, 1 mL of a solution containing 0.25% bupivacaine and 40 mg of Depo-Medrol was injected at each site. A sterile bandage was placed at each entry point. The patient tolerated the procedure well.
 

mcnaryk

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I believe since it's per NERVE or BRANCH, and he only targeted the femoral nerve (albeit by different approaches), it would only be coded once.
 

tatumroe

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Genicular nerve block 64450

Thank you ladies. Can anyone give an example of when it would be appropriate to code it more than once? And would its be multiple lines with a 51 not one line with multiple units correct?
 

vmejias43

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Provider service: left knee nerve block of the Superior lateral, medial superior and inferior Genicular nerves and the sub patella nerve under fluoro in office today. I am a bit confused on the sub patella nerve. 64454 Indicate the 3 Genicular nerves however the fourth injection I was going with a 64450 or 64447. Please help
 
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