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Wiki Intercostal Nerve Blcok
- Thread starter lump2009
- Start date
Code 64420 once for a single stick. Code 64421 once for multiple sticks.
Richard Mann, your pain management coder
rkmcoder@yahoo.com
Richard Mann, your pain management coder
rkmcoder@yahoo.com
vjtiwari99
Guru
I think once.
Be'coz, 64421 says... intercostal nerves, multiple, regional block.
And you are mentioned T5-6. (two. so not 64420).
Be'coz, 64421 says... intercostal nerves, multiple, regional block.
And you are mentioned T5-6. (two. so not 64420).
dwaldman
True Blue
"The physician anesthetizes the intercostal nerve to block chest wall pain. In 64420, a single injection is performed. In 64421, multiple nerves are injected to provide pain relief to a larger area (regional block)."
From Encoder, this description I feel helps clarfiy that 64421 is only billed once for mulitple nerves.
From Encoder, this description I feel helps clarfiy that 64421 is only billed once for mulitple nerves.
marvelh
Expert
In a T5-T6 intercostal nerve block, the physician is blocking only a single intercostal nerve, T5, that is in the T5 & T6 interspace aka between the fifth and sixth thoraic ribs. So if the documentation is a dash, then it would be a single injection or 64420.
If the physician performed T5 and a T6 intercostal nerve blocks, he would be blocking not only the T5 intercostal nerve located as above between the T5 & T6 interspace but also a second injection to block the T6 intercostal nerve in the T6 & T7 interspace aka between the sixth & seventh thoracic ribs. Since more than 1 intercostal nerve injection was performed, this would be a multiple block or 64421.
The key is - Is the physician describing the needle placement location: T5-T6 or the specific intercostal nerves blocked: T5, T6. Something as simple as a dash or comma can change the coding - that is why it is important that we can't code from a procedure title but also need to verify the procedures in the procedure documentation detail section and/or confirm with the physician.
If the physician performed T5 and a T6 intercostal nerve blocks, he would be blocking not only the T5 intercostal nerve located as above between the T5 & T6 interspace but also a second injection to block the T6 intercostal nerve in the T6 & T7 interspace aka between the sixth & seventh thoracic ribs. Since more than 1 intercostal nerve injection was performed, this would be a multiple block or 64421.
The key is - Is the physician describing the needle placement location: T5-T6 or the specific intercostal nerves blocked: T5, T6. Something as simple as a dash or comma can change the coding - that is why it is important that we can't code from a procedure title but also need to verify the procedures in the procedure documentation detail section and/or confirm with the physician.
dwaldman
True Blue
Thanks for explaining this I totally missed that point when I responsed.