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cpt for superficial dermatomal injection

  1. #1
    Location
    Pasadena, CA
    Posts
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    Question cpt for superficial dermatomal injection
    Medical Coding Books
    Need help with pain management. Doc did "multiple superficial dermatomal injections" for postherpetic neuralgia.

    OP report: The area over the left thoracic wall and axillary area was marked as the most senstivite area of postherpetic neuralgia symptoms. Using a 22-gauge spinal needle, 0.25% Marcaine w/ epinephrine in combination w/ methylprednilosone was injected throughout the area involved subcutaneously for a total of 26mL of solution. All needles were removed intact.

    Conflicted betwen coding a sub-q injection (93672) or regional intercostal nerve block (64421) or what???

    ANY comment greatly appreciated,
    Diane

  2. #2
    Thumbs up Answer to your coding question
    I would choose the sub-q code. The injection was done subcutaneously as stated in the note.

    MK

  3. #3
    Default
    Quote Originally Posted by diane1217 View Post
    Need help with pain management. Doc did "multiple superficial dermatomal injections" for postherpetic neuralgia.

    OP report: The area over the left thoracic wall and axillary area was marked as the most senstivite area of postherpetic neuralgia symptoms. Using a 22-gauge spinal needle, 0.25% Marcaine w/ epinephrine in combination w/ methylprednilosone was injected throughout the area involved subcutaneously for a total of 26mL of solution. All needles were removed intact.

    Conflicted betwen coding a sub-q injection (93672) or regional intercostal nerve block (64421) or what???

    ANY comment greatly appreciated,
    Diane
    96372 is a component of 64421. You shouldn't bill for the Anesthetic; only bill for cortosteroids (J codes).

    Authoratative Documentation from CMS:

    Medicare Part B Local Coverage Determination

    "CPT codes, descriptions, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply."

    Contractors Determination Number: AC-03-041

    Contractor Name: Medicare Services

    Contractor Number: 00520, 00524, 00528

    Contractor Type: Carrier

    LCD Title: Intercostal Nerve Blocks/Neurolysis

    AMA CPT Copyright Statement: "CPT codes, descriptions, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply."

    CMS National Coverage Policy: Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary.
    Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
    Title XVIII of the Social Security Act, section 1862(a)(7) excludes routine physical evaluations.


    Primary Geographic Jurisdiction: 00520 - Arkansas
    00524 - Rhode Island
    00528 Louisiana

    Secondary Geographic Jurisdiction: Not applicable

    Oversight Region: Region I Boston (RI) Region VI Dallas (AR, LA)

    CMS Consortium: Northeast (RI) Southern (AR, LA)

    DMERC Region LCD Covers: Not applicable

    Original LCD Effective Date: 10/01/2006 (RI) 04/15/2004 (AR, LA, MO, NM, OK)

    Revision Ending Date: 02/29/2008 (NM, OK)
    05/31/2008 (MO)
    04/30/2009 (RI)

    Indications and Limitations of Coverage and/or Medical Necessity: Chronic neuralgic pain secondary to an injured intercostal nerve(s) as a result of rib fracture, a thoracotomy incision or the chronic pain due to post herpetic neuralgia or chronic pain secondary to benign or malignant processes.

    Type of Bill Code: Not applicable

    Revenue Codes: Not applicable

    CPT/HCPCS Codes: This policy does not take precedence over the Correct Coding Initiative (CCI). Consult current correct coding guidelines for applicable specific code combinations or reductions in payment due to specific codes billed.

    The following short descriptors are in accordance with the AMA copyright agreement. Please refer to the current CPT book for full descriptions.
    64420 N block inj, intercost, sng
    64421 N block inj, intercost, mlt
    64620 Injection treatment of nerve

    ICD-9 Codes that Support
    Medical Necessity:
    053.10 Herpes zoster with unspecified nervous system complications
    053.13 Postherpetic polyneuropathy
    053.14 Herpes zoster myelitis
    195.1 Malignant neoplasm of thorax
    338.0 Central pain syndrome
    338.11-338.19 Acute pain
    338.21-338.29 Chronic pain
    338.3 Neoplasm related pain (acute)(chronic)
    338.4 Chronic pain syndrome
    353.8 Other nerve root and plexus disorders
    724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified
    733.6 Tietze's disease
    807.00-807.09 Rib(s), closed fracture
    807.4 Flail chest
    998.9 Unspecified complication of procedure, not elsewhere classified

    Diagnosis that Support Medical Necessity: Not applicable

    ICD-9 Codes that DO NOT Support Medical Necessity: Not applicable

    Diagnosis Codes that DO NOT Support Medical Necessity: Not applicable

    Documentation Requirements: 1. Medical necessity for performing the procedure must be clearly documented in the medical records.
    2. Claims must be submitted with appropriate diagnosis information, such as ICD-9-CM codes coded to the highest level of specificity.

    Utilization Guidelines:

    Sources of Information and Basis for Decision: 1. Satterhwaite, Dollison. Handbook of Pain Management, 2nd Edition, 1994, Williams and Wilkins.
    2. Yale University School of Medicine, Department of Pain Management.
    3. Connecticut Society of Anesthesiology.
    4. Local Medical Policy from Nationwide Insurance Company, Louisiana, and Arkansas.
    5. Medicare Operations Spine Five: 1980; 193 200.
    6. Journal of Neurosurgery 1975;43:448-451.
    7. Joint section on pain, the American Association of Neurological Surgeons and Congress of Neurological Surgeons.
    8. American Pain Society.

    Advisory Committee Notes: The Arkansas consortium combined LCD was presented in December 2003 (AR, LA, MO, NM, OK) and March 2006 (RI) and accepted.

    "This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from all recognized specialties within the state."

    Start Date of Comment Period: 03/15/2006 (RI) 11/17/2003 (AR, LA, MO, NM, OK)

    End Date of Comment Period: 04/30/2006 (RI) 01/15/2004 (AR, LA, MO, NM, OK)

    Start Date of Notice Period: 08/15/2006 02/29/2004 (AR, LA, MO, NM, OK)

    Revision History:
    04/06/2009 PBSI Part B policy retired in Rhode Island due to workload transition to J14 MAC contractor (NHIC).
    05/31/2008 PBSI policy retired in Missouri due to workload transition to J5 MAC contractor (Wisconsin Physicians Services).
    02/29/2008 PBSI policy retired in New Mexico and Oklahoma due to workload transition to J4 MAC contractor (Trailblazer Health Enterprises, LLC).
    07/11/2006 Added ICD-9 codes 053.14, 338.0, 338.11-338.19, 338.21-338.29, 338.3, and 338.4 due to the 2007 coding update (CR5142) and effective 10/01/2006.

    Policy revised to include Rhode Island (00524). This policy was presented to the RI CAC on 03/22/2006, released on 08/15/2006 in the August 2006 newsletter, and effective with DOS 10/01/2006.
    03/01/2006 Deleted ICD-9-CM code 053.14. This code was published in the 2006 ICD-9-CM book but was not approved and is not valid.
    01/11/2006 Added new 2006 ICD-9 code 053.14 to allow effective 10/01/2005. This codes was new in 2006 ICD-9 book but was not included in CR for annual release.
    12/01/2005 Reformatted to LCD. Added CCI statement to HCPCS/CPT section.
    Chastity Nault, CPC
    HIM Professional Services Coder - Remote

  4. #4
    Default Sub-q vs nerv inj
    I would agree with using Sub-q injection CPT 96372, as that's what the note describes- no mention of nerves in the note. I'd also add the J code for the steroid if this was an in-office injection-drug supplied by the MD (vs facility). The Coder's Desk Reference states that for a 64420 'the physician anesthetizes the intercostal nerve..' and in 64421 'multiple nerves are injected...'. Many nerve injections from pain management providers utilize fluoroscopic guidance to ensure they get to the correct nerve site. If you have any question about whether or not a nerve was injected, query the provider.
    Hope this helps...

    Cindy L. Swan, CPC

  5. Default
    Nicely put Cindy. I agree, you only use the Jcodes if your provider is supplying the meds.

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