Bilateral procedures should be reported as such
with the 50 modifier on a single line
or modifier RT and Modifier LT with the CPT on two separate lines
There are a couple of procedures to consider such as a bilateral procedure or multiple procedures invovling separate injections on the same side of the trigeminal branch. From CPT Assistant which I have copy and pasted, is a great Q and A that I had recently seen when searching the CPT Assistant archives on Encoder and it is good to share this if you have had chance to see this one. The questionioner also I noticed has an article in AAPC Coding Edge for June 2011.
Trigeminal nerve block performed bilaterally is recognized by CMS payment indicators as be able to reported with the modifier 50 as such 64400-50
or as below for carriers that does better with
Below is from AMA CPT Assistant December 2008. __________________________________________________ ___________________
Question:If a provider injected two separate unilateral branches or divisions of the trigeminal nerve (eg, injected the right supraorbital branch [V1] and also injected the right infraorbital branch [V2]), would these injections be reported as two units of code 64400 or just one unit, as the code description states âany division or branchâ?
Marvel J. Hammer, RN., Denver, CO
Answer:Code 64400 should be reported once for the injection into the right supraorbital nerve. Code 64400 with modifier59, Distinct procedural service, appended should be reported for the right infraorbital branch injection. The descriptor of code 64400 represents a single injection into a single nerve in the anatomy and sensory distribution of the peripheral trigeminal nerve. Injection of each specific nerves has effects on different anatomy sensation in different areas.
An understanding of the neural distribution is key, since the right supraorbital nerve is above the orbit of the eye (about at the level of the eyebrow on the forehead), whereas the infraorbital nerve is below the orbit (lateral to the nose, middle of the face, and midline with the pupil of the eye).
To illustrate, the trigeminal nerve is the main cutaneous sensory nerve of the face and head, with three main branches (V1, ophthalmic; V2, maxillary; and V3, mandibular), each with its own nerve divisions. The right frontal nerve is a continuation of the ophthalmic nerve. The right supraorbital nerve leaves the orbit through the supraorbital foramen, providing filaments to the upper eyelid and the frontal muscles. The right infraorbital nerve is in the maxillary branch of the trigeminal nerve. The maxillary nerve becomes the infraorbital nerve, which emerges onto the face through the intraorbital foramen, thus providing cutaneous innervation to the middle of the face, lower eyelid, side of the nose, and upper lip.
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