betsycpcp
Networker
Hello,
I'm looking for opinions and also where to find official guidance if possible - a provider is billing 64420 (injection anesthetic agent and/or steroid; intercostal nerve single level). The report shows that they did 2 blocks for shoulder surgery - an interscalene which was billed with 64415 and "ICB" (intercostobrachial) which was billed with 64420. The lay description for 64420 says the injection is done "near the intercostal nerves, which are located underneath the ribs" for pain from herpes zoster infection or a surgical incision. It's also done for pain from rib fractures from what I've read, and I've seen photos with the location being on the back, in the thoracic area beneath several ribs.
If you google intercostobrachial block, on nysora.com they have an article "Cutaneous Blocks for the Upper Extremity" and it describes the intercostobrachial block as being done along the axillary crease, near the armpit, for upper arm procedures. So nowhere near the ribs or thoracic area. I have seen in just a couple of places that 64450 should be used, which makes sense to me since 64420 is intended for a different block, at a different location. Does anyone have any references or experience regarding these?
Thanks.
I'm looking for opinions and also where to find official guidance if possible - a provider is billing 64420 (injection anesthetic agent and/or steroid; intercostal nerve single level). The report shows that they did 2 blocks for shoulder surgery - an interscalene which was billed with 64415 and "ICB" (intercostobrachial) which was billed with 64420. The lay description for 64420 says the injection is done "near the intercostal nerves, which are located underneath the ribs" for pain from herpes zoster infection or a surgical incision. It's also done for pain from rib fractures from what I've read, and I've seen photos with the location being on the back, in the thoracic area beneath several ribs.
If you google intercostobrachial block, on nysora.com they have an article "Cutaneous Blocks for the Upper Extremity" and it describes the intercostobrachial block as being done along the axillary crease, near the armpit, for upper arm procedures. So nowhere near the ribs or thoracic area. I have seen in just a couple of places that 64450 should be used, which makes sense to me since 64420 is intended for a different block, at a different location. Does anyone have any references or experience regarding these?
Thanks.