Nerve Blocks (Digital, Dental, Peripheral, etc.) FAQ
FAQ 1. Can I bill for Digital
payers following CPT guidelines, this service, code 64450 (Injection, anesthetic agent; other peripheral nerve or
branch) or any other type of nerve block can no longer be separately coded when
performed as a component of a surgical procedure. In this instance, a digital
nerve block is clearly bundled as part of the global surgical package, as
outlined in the CPT Introduction to the Surgical section-CPT Surgical Package Definition. Under
Medicare's global services package rules, digital nerve blocks have long been
bundled when performed as a component of a surgical procedure. For example,
when performing a nerve block for a laceration repair of a finger, only
the laceration repair should be coded and not the nerve block.
digital nerve blocks performed as a stand-alone procedure and not part of a
surgical package (e.g., for pain control alone) generally remain separately
codeable under both Medicare and CPT coding principles.
FAQ 2. Can I bill for Dental
blocks are a billable procedure.
CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch)
or CPT 64400 (Injection, anesthetic agent; trigeminal nerve, any division or
branch) can be coded when performing associated dental nerve blocks.
appropriate Evaluation/Management code modified with a -25 modifier may be used in addition to the nerve block code to
identify a significant, “separately identifiable” medical
FAQ 3. Some ER physicians are performing
peripheral nerve blocks for procedural anesthesia or pain control (e.g.,
femoral nerve blocks for hip fractures). Are these procedures billable?
are multiple nerve blocks that are codeable in CPT. These codes are dependent on
the anatomical location of the nerve being blocked (CPT codes 64400-64530). It
is important to be specific in your procedure note as to which nerve is being
FAQ 4. What if I use Ultrasound
guidance in order to perform my nerve blocks?
the use of ultrasound guidance to perform a nerve block is also a separately
billable procedure. CPT code 76942 [Ultrasonic guidance for needle placement
(e.g. biopsy, aspiration, injection, localization device) imaging supervision
and interpretation] could be coded as well as the specific nerve block code.
titled: Digital Block FAQ
named: Nerve Blocks (Digital, Dental,
Peripheral, etc.) FAQ
American College of Emergency Physicians (ACEP) has developed the Reimbursement
& Coding FAQs and Pearls for informational purposes only. The FAQs and Pearls have been developed by
sources knowledgeable in their fields, reviewed by a committee, and are
intended to describe current coding practice. However, ACEP cannot guarantee
that the information contained in the FAQs and Pearls is in every respect
accurate, complete, or up to date. The
FAQs and Pearls are provided "as is" without warranty of any kind,
either express or implied, including but not limited to, the implied warranties
of merchantability and fitness for a particular purpose. Payment policies
can vary from payer to payer. ACEP, its committee members, authors or editors
assume no responsibility for, and expressly disclaim liability for, damages of
any kind arising out of or relating to any use, non-use, interpretation of, or
reliance on information contained or not contained in the FAQs and Pearls. In
no event shall ACEP be liable for direct, indirect, special, incidental, or
consequential damages arising out of the use of such information or material.
Specific coding or payment related issues should be directed to the payer. For
information about this FAQ/ Pearl, or to provide feedback, please contact David
A. McKenzie, CAE, Reimbursement Director, ACEP at (972) 550-0911, Ext. 3233 or firstname.lastname@example.org.