Here kind of a similiar question of doing a single injection but considering that mulitple nerves could be treated with one injection. If I would of noticed when i provided my initial response that only one injection was performed, I would thought of procedure notes that i have seen where one of the doctors who used be with the group would describe both greater and lesser in a single injection. But at time he was performing and dictating these, I was billing 64405 only and he was marking it on the superbill like that. If I had to select the codes for a procedure note like that again, I would look at the descriptors, each descriptor for 64405 and 64450 involves an injection. So each code is valued based on the concept that you are providing an injection when reporting this code. If a single injection is performed, I don't think an additional injection procedure would be justified since there was not an additional injection.
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Date: 09/21/2010
Surgery
Nervous System
Question
If a single injection is performed for a thoracic intercostal nerve block, the effect of which is to block multiple intercostals nerves, is it appropriate to report CPT code 64421, Injection, anesthetic agent; intercostal nerves, multiple, regional block, or is the provider limited to reporting CPT code 64420, Injection, anesthetic agent; intercostal nerve, single?
Answer
“Single” injection refers to a single nerve block, so code 64420 should be reported. However, if only one needle is placed into the skin but manipulated up and down to inject into more than one nerve, it may be possible to report multiple blocks (code 64421). However, from a clinical perspective, blocking multiple intercostal nerves with a single injection is hard to do in most settings.