Wiki Occipital and Trigeminal Nerve Block Coding Question

[PLDalsoren]

Hello Everyone,
I work for a medical billing company and we just took over billing for a Neurology practice. I am currently working through claim denials and found a claim that the previous company had submitted incorrectly. They billed 3 separate lines of CPT 64405-LT to Medicare which were denied.

I checked the procedure note and the provider states he did a left occipital nerve block in three places along the left mastoid process and the occipital protuberance. He then did a trigeminal nerve block along the left ophthalmic, maxillary and mandibular branches of the trigeminal nerve.

This is a brand new specialty for me so I am feeling extremely lost on how to code this correctly. I know to use CPT code 64400 and 64405 but am unsure how many units of each I am able to report?

Thank you for any assistance you can provide!

 

[tmorgan808]

The occipital is considered one unit because he is injecting the same nerve., unless performed bilaterally. The trigeminal nerve is billed per branch.
Summary
The provider injects an anesthetic agent and/or steroid close to each branch of fifth cranial nerve, also called the trigeminal nerve, a mixed cranial nerve that is composed of three large branches — ophthalmic, maxillary, and mandibular. Report this code for each branch of the trigeminal nerve injected during a single procedure.