AAPC - Back to school
Results 1 to 5 of 5

Thread: Lesser Occipital Nerve Block

  1. #1

    Smile Lesser Occipital Nerve Block

    AAPC: Back to School
    Two questions: Should a lesser occipital nerve block be billed 64450:other peripheral nerve or branch? The greater occipital block CPT code is 64405 (no mention of lesser). Is the greater and lesser occipital nerves actually two separate nerves or are they joined together at some point?

  2. #2
    Join Date
    Apr 2007
    Denver Colorado


    The lesser occipital nerve originates from the lateral branch of ventral portion of the C2 and sometimes the C3 spinal nerve. It provides sensory innervation to the lateral scalp area behind the ear. Report with 64450 as there isn't a specific code for lesser occipital nerve injection

    Whereas the greater occipital nerve originates from the medial branch of the dorsal portion of the C2 spinal nerve and provides sensory innervation to the midline back of the scalp area. Report with 64405

    Here is a link for an illustration that shows the two separate nerves: http://2.bp.blogspot.com/_yujaake5T5...craniotomy.bmp

  3. #3


    Thank you, your assistance in this is "greatly" appreciated!!

  4. #4

    Default occipital nerve block

    If the doctor states he injected both greater and lesser occipital nerves, would I then bill for both 64405 and 64450? If he doesn't state a specific nerve he injects and calls the procedure an occipital nerve block, would you code for the GONB 64405?

  5. #5
    Join Date
    Apr 2007


    christyboutwell ,

    I would recommend that you relay to the physician he needs to document greater occipital nerve if that is the nerve targeted in the procedure he performed for billing 64405.
    When reviewing the RVUs of 64405 which is 1.82 with around a $65.16 reimbursement for a unilateral injection. Compared to the CPT 64450 with an RVU of 1.31 with around a $46.90. Which could be around a 20 dollar overpayment if not properly documented and only the lesser was blocked.

    With the difference in reimbursement, you want to make sure you are correctly reporting to the carrier 64405 only for greater occipital nerve blocks if you are billing for a provider who also blocks the lesser occpitial nerve in some situations.

    Although 64405 and 64450 do not have a code edit with CMS NCCI. I would ensure that that the consent for the procedure includes both the greater and lesser occipital nerves and the procedure note clearly describes both sets of nerves being separately injected and potentially reasoning why the lesser will also be targeted in addition to billing for the injection of the greater occipital nerve. I have personally only billed for the greater occipital nerve under 64405 and not the dual procedure of greater and lesser so I am not fully research carriers response to being billed for both the greater and lesser occipital nerve.

Similar Threads

  1. Replies: 2
    Last Post: 12-14-2015, 09:44 AM
  2. Greater & Lesser Occipital Nerve RFA
    By ajkinion in forum Anesthesia
    Replies: 2
    Last Post: 09-23-2011, 09:07 AM
  3. Lesser Occipital Nerve
    By NESmith in forum Anesthesia
    Replies: 4
    Last Post: 01-24-2011, 08:54 PM
  4. third occipital nerve block
    By dwaldman in forum Anesthesia
    Replies: 4
    Last Post: 04-15-2010, 10:02 AM
  5. Lesser Occipital Nerve Injection
    By janelkonda in forum Anesthesia
    Replies: 1
    Last Post: 11-21-2008, 10:01 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.