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Thread: Multiple intercostal nerve blocks

  1. #1

    Default Multiple intercostal nerve blocks

    AAPC: Back to School
    MD dictates that injection was done at the inferior aspect of left T4 rib...this was repeated at left T5, T6, T7 intercostal level. Everything we can find dictates that only 3 units may billed at a time. Any suggestions?

  2. #2
    Join Date
    Apr 2007


    For multiple nerves treated with mulitple injections you bill 64421 with quantity one. It is not per injection

    Below is CPT Assistant article and lay description from Encoder

    Ignenix Encoder
    The physician anesthetizes the intercostal nerve to block chest wall pain. In 64420, a single injection is performed. In 64421, multiple nerves are injected to provide pain relief to a larger area (regional block).

    __________________________________________________ _____________________

    CPT Assistant November 2010

    Surgery: Nervous System

    Question:If a single injection is performed for a thoracic intercostal nerve block, the effect of which is to block multiple intercostal nerves, it is appropriate to report CPT code 64421,Injection, anesthetic agent; intercostal nerves, multiple, regional block,or is the provider limited to re-
    porting code 64420,Injection, anesthetic agent; intercostal nerve, single?

    Answer:From a CPT coding perspective, “single injection” means “single nerve block.” Therefore, code 64420 should be reported. If only one needle is placed into the skin but manipulated up and down to inject into more than one nerve, it may be possible to report multiple blocks (code 64421). However, from a clinical perspective, blocking multiple intercostal nerves with a single injection is hard to do in most settings.

  3. #3


    64421 which is for multiple

  4. #4

    Default more on 64421 & 64420

    I am still a little confused over these codes and would appreciate more guidance. T8/9/10/11/12 were all injected. What would be the proper coding? Would 64421 be used for the first level followed by 64420 with a modifier? Would 64420 be billed more than once? Thank you for your help with this.

  5. #5
    Join Date
    Apr 2007


    64421 is reported once to represent multiple intercoastal nerves blocked.
    64420 is reported once if only a single intercoastal nerve is blocked.
    If performed bilateral, modifier 50 or RT and LT could be used.

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