Lesser Occipital Nerve

NESmith

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My provider did the procedure Left greater occipital nerve block and left lesser occipital nerve block. He states in his report with the use of a 25 gauge 1-1/2 inch needle we introduced the needle along the superior nuchal ridge at the level of the mastoid process and in a fanlike motion injected 10 cc of the premixed solution on a superficial distribution of the Greater and Lesser occipital nerve both on the left side. The CPT codes billed were 64405 for the Greater Occipital nerve and 64450 for the lesser Occipital nerve. The insurance company is denying the CPT ciode 64450 stating it is not the correct code. I was always told that CPT does not have a code specifically for the LON injection, so report it with CPT code 64450. Has something changed? We have sent this to appeals and they are still denying. Any suggestions? Thanks for your help
 

dwaldman

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I did not see an edit for 64450 & 64405. Have the physician provide an explanation of therapeutic benefit for the second appeal.
 

NESmith

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Yes, that is correct, there was only one injection, so does that mean even though the injection was done in a fanlike motion the only CPT code should have been 64405? You all are great helping me. Thanks
 

dwaldman

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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.
 
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