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Popliteal and saphenous nerve blocks

  1. #11
    Clearnace Sale
    I would have the doctor specifiy which nerve that he is blocking since the descriptor says sciatic nerve for 64445, you want the procedure note to match the code that you are billing. We have a doctor that goes to the outyling facilities and performs sciatic, femoral, common peroneal, and sural nerve blocks. If the documentation states a nerve that matches a code that refers to the nerve in the descriptor of the code than I used the code if there is not a code that mentions the nerve he is blocking I use 64450. In the situation you are describing it is like an either or situation. I would tell the physician I have to be able to choose between 64445 or 64450. Ask which would better describe what he is targeting-- the main sciatic branch or a other peripheral branch. Sometimes the further explanation from the physician who performed can clarify the code selection and if it requires for him to better describe this in the procedure note for the payer to understand you might need for him to add to the note. I am not familiar with this approach to be able to say this is more describe better with one code rather than another. I would stick with the concept if the nerve blocked is described in the descriptor than use that code but just because a nerve is a branch of another nerve I would not use the main nerve code just because the nerve that was blocked is branch of a nerve which a code is set up for.

  2. #12
    Denver Colorado
    If the injection is above the sciatic nerve division into the posterior tibial and peroneal nerve, then it would be appropriate to code it as a sciatic nerve injection or 64445

  3. #13
    "The popliteal nerve block is a block of the sciatic nerve in the popliteal fossa with the patient in the prone position."

    "It is the site where the sciatic nerve splits into its two major components,
    the tibial and common peroneal nerves (Figure 20-1). To avoid an incomplete nerve block, the needle entry site must be proximal to the splitting of these two nerves (Figure 20-2). Studies have demonstrated that the needle
    entry point should be 10 cm from the popliteal crease to optimize needle placement."

    This link and many others I saw on the internet refer to this approach as blocking the sciatic nerve. If the documentation is unclear that he blocked the sciatic nerve before it branches out. I would ask the physician to clarify that the sciatic nerve is indeed the nerve he blocked.

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