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Dictation requirements for intercostal nerve injections

  1. Default Dictation requirements for intercostal nerve injections
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    I am in serious need of help! I am assisting with our Rheumatology clinic and even though I have a background in Ortho I am not too familiar with this procedure.
    I requested clarification from the provider on this note:

    NOTE: The procedure is an intercostal nerve block. The reason for the procedure is severe intercostal neuralgia and pain. The medication injected for each injection was 1 cc of 1% lidocaine mixed with 0.5 cc of triamcinalone acetonide ( 15mg/ml). This was only (1) injection with kenalog.
    The patient also received 8 additional injections of 1% lidocaine only with no epi for a total of 9 injections.
    *
    Sedation medication: None
    Complications: None
    *
    Technique: Consent was signed, time out was done to identify the target area with the patient. This was done by careful palpation. Tenderness was elicited over the intercostal nerve roots by palpation which caused reproducible pain. Then using a 27 gauge 1.5 inch Monject needle the nerve root was injected very carefully by gently advancing the needle on a 20 degree angle until it dipped just below the nerve. The area was then injected at multiple sites along the nerve dermatome.

    He is wanting to bill out 64421 and I just asked what nerves he was injected and he told me to just bill it out as he has always done it this way?
    I am not able to find anything that just says this is ok...
    I would appreciate any help.
    Thank you

  2. #2
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    Hi,
    64421 says injection of anesthetic agent in intercostal nerves so the code is correct and as the intention is to reduce the pain in nerves. I think that your physician is correct and it should be billed as given code.

    Regards
    Ritika Sinha

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