Multiple Post Op Pain Injections

Melissa-ASL-PMB-07

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Richmond, IN
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Hello,
I have seen some providers utilize many different combinations of blocks for post op pain relief.
Some combinations are billed with using a single code, and I understand it is considered inclusive since it is blocking the same general region.

For example,
Interscalene injection is performed on the right
Supraclavicular injection is performed on the right
Then a T2 intercostal injection is performed on the right

How would you code? (keep in mind this is for post op pain in conjunction with an anesthesia charge, so I applied the -59)

64415-59-RT would be 2 units but only one unit is allowed per MUE, unless proven necessary with appeal.
64420-59

or would it ever be appropriate to bill as:
64415-59-RT
64450-59-RT claim note stating: Supraclavicular Block
64420-59

There are other scenarios that I have seen that fall under similar circumstances.
For example an Adductor Canal Block performed with an additional Femoral n block and a Fascia Iliaca n block
64447 only billed once?
or could we claim the 64450 for the adductor canal and fascia iliaca since the CPT code descriptor does not specifically state to use 64447 for these additional blocks.

Providers believe strongly that they should be reimbursed for each injection.
I agree to an extent because the different nerves are blocked for a reason. If these block combinations were not performed together, a different result would occur, possibly leaving the patient with pain management treatment that was not as effective. With the drug issues we have today, effective post operative pain management is crucial to fight this epidemic.

What are your thoughts?
Thank you in advance.
 
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