Wiki help with 64420, 64421

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HI
Physican billed 64420 and 64421*3.
He says he treated 4 nerves from T3-T9. However , he did not document the name of the nerves or the levels in his procedure. He just mentioned he injected needle into T5 dernatome.

I want to understand these codes. What does 'level' mean in the code descriptor? This is how I am interpreting: If 1 injection is given at T3 and 4 nerves are treated , then code 64420.
If a single injection is given at T3 to treat 1 nerve , and 3 nerves on other levels from T4 to T9, then code 64420, 64421*3?

Any guidance is much appreciated. Thanks
 
If he said he injected the dermatome I wonder if it was a plane flooding procedure. Is there anything in the note about how much drug he used?
 
Hi jkyles, He did say the procedure utilizes a large volume of fluid which spreads to multiple levels.

Procedure note: The patient was brought into the procedure room and was placed in {RIGHT LEFT BILATERAL:11262} Lateral Decubitus position on the procedure table and extensively draped and prepped in a sterile fashion. A pre-procedural time out was performed: The patient's name, date of birth, location and type of procedure were confirmed with the patient and clinical staff. The ultrasound machine was used to identify the appropriate serratus anterior plane along with critical structures including pleura and ribs. Skin was anesthetized with 1 cc of lidocaine 1% via a 25 G 1 1/2 inch needle. Through the anesthetized skin we introduced a 22 G 3 1/2 inch Quincke spinal needle into the previously identified serratus anterior plane at the T5 dermatomal level under live ultrasound guidance. After negative aspiration for heme, air and fluids and no paresthesia whatsoever we injected 3 mg DepoMedrol with 30 cc of Bupivacaine 0.25%. Needles were taken out and were intact, and the site was cleaned and dressed. The patient was discharged home in good condition with written discharge instructions.
 
per surgeon "there is one needle placed at one level, and the medication then is expected to spread to multiple levels, blocking multiple nerves including intercostal nerves as well as others."
 
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