Wiki Pain Block Question

mnmd9488

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Hi, I have an anesthesiologist who is wanting to charge multiple blocks for his pts and I am not sure if we should add them individually or just use 1 code.

Pt had and ORIF of their finger with general anesthesia. Their post op pain blocks are listed as median nerve block and ulnar nerve block. They are both part of the brachial plexus so would I just do 64415 or do I code 64450 for each nerve block?
 
Hi there, from the CPT manual:

Codes 64400-64450, 64454 describe the injection of an anesthetic agent(s) and/or steroid into a nerve plexus, nerve, or branch. These codes are reported once per nerve plexus, nerve, or branch as described in the descriptor regardless of the number of injections performed along the nerve plexus, nerve, or branch described by the code.
 
Use 64415 once with 59, RT or LT. If ultrasound is also documented with the image saved to the patient's chart, you may also bill 76942-26. (not valid in 2023)
 
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Quick question the code 76942 has been deleted in the 2023 crosswalk manual but listed in the 2023 relative value guide. What code are you using when a block is performed? We have been using the code 76942-26 but ruining into issues with payers denying as bundled with block code. If you have a contract with a payer and it is listed as part of the fee schedule for reimbursement, are they obligated to pay the code or not? Should the contract be amended?
 
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Quick question the code 76942 has been deleted in the 2023 crosswalk manual but listed in the 2023 relative value guide. What code are you using when a block is performed? We have been using the code 76942-26 but ruining into issues with payers denying as bundled with block code. If you have a contract with a payer and it is listed as part of the fee schedule for reimbursement, are they obligated to pay the code or not? Should the contract be amended?
Hi there, these are two separate issues. The payer covers the needle guidance service, but in some instances the guidance service is bundled into another service. The majority of nerve block codes now include image guidance services, so depending on the block reported the denial would make sense.

See 76942 in the CPT manual and the payer's bundling edits for a complete list of codes that include ultrasound guidance. If the combination you're billing is not in either of those places, I would appeal.
 
Quick question the code 76942 has been deleted in the 2023 crosswalk manual but listed in the 2023 relative value guide. What code are you using when a block is performed? We have been using the code 76942-26 but ruining into issues with payers denying as bundled with block code. If you have a contract with a payer and it is listed as part of the fee schedule for reimbursement, are they obligated to pay the code or not? Should the contract be amended?

See page 479 of the 2023 CPT manual for a chart indicating which codes have U/S bundled and which codes can be billed with 76942.
 
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