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Occipital Nerve Block, Facial Chemodenervation, and Paraspinal Trigger point injections billed in same visit

latoshac

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9
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Pascagoula, MS
Hello, We typically perform (TP/ONB) Trigger Point/Occipital Nerve Blocks for migraines and neck pain in the hospital outpatient clinic. The provider has added chemodenervation for TMJ on the same visit. Normally we bill 20552- XU, 64450 and 64405-50 for the following documentation:

"The occipitocervical junction overlying the greater occipital nerves was also cleansed w/ alcohol. A total of 20cc of bupivacaine 0.5% (divided into 14 injections) were administered intramuscularly over the bilateral greater and lesser occipital nerves (2 sites on each side-10cc total), bilateral sub-occipital nerves (1 site on each side-3cc total), and among the identified trigger points "

With the addition of the Xeomin injection documentation"
"5 units of Xeomin were delivered with each injection to predetermined injection sites including the Temporalis (2 sites on each side-20 units total), and Masseters (3 sites on each side-30 units total)."

I would add 64612 -50 but the codes will not clear the encoder. Any help with this issue would be greatly appreciated,
 
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