Wiki ilioinguinal nerve botox coding


Belton, MO
Best answers
My physician did a therapeutic ilioinguinal nerve block and neurolysis with botox under ultrasound guidance. I would normally code the nerve block as 64425 but I am having trouble with the chemodenervation code for the botox of the ilioinguinal nerve. Coding guidelines for the destruction by neurolytic agent/chemodenervation section say not to report diagnostic/therapeutic injections separately so I know I shouldn't report 64425 with the other code. What should I code for this procedure?? Any help is appreciated!
Without seeing the operative report I would suggest looking at 64640 as this would be chemodenervation of the peripheral nerve branch.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
Melissa, thank you for the ideas! Here is the procedure note to hopefully provide some clarification on code selection.

"The right ilioinguinal nerve was injected today. The ipsilateral anterior superior iliac spine was identified. A point 2 cm medial and 2 cm inferior to the ASIS was located, and palpation at the site elucidated an exacerbation of the patient's pain. Alcohol prep was applied, and utilizing a 27 gauge 1 1/2 inch needle the tip was advanced at the point through the anterior abdominal muscular fascia, negative aspiration obtained, and in a fanlike distribution a total of 4 cc Marcaine 0.25% with 30 unites of botox were injected. It was tolerated very well, with transient stimulation of the normal pain pattern. 170 units of Botox were discarded."

Coding thoughts?
Look at 64646. The injection of marcaine would be considered not separately reportable from the chemodenervation injection.