Nerve Blocks (Digital, Dental, Peripheral, etc.) FAQ

FAQ 1. Can I bill for Digital Nerve Blocks?

For 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 always been bundled when performed as a component of a surgical procedure. Thus, when performing a nerve block for a laceration repair of a finger, only the laceration repair should be coded and not the nerve block.
However, 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?
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 or branch) can be coded when performing dental nerve blocks.
The 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 service.

FAQ 3. Some ER physicians are now doing increased peripheral nerve blocks for control of pain such as a femoral nerve block for hip fractures. Are these procedures billable?
There are multiple nerve blocks that are codeable in CPT. These codes are dependant 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 blocked.

FAQ 4. What if I use Ultrasound guidance in order to perform my nerve blocks?
Generally, 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.
Was titled: Digital Block FAQ
Now named: Nerve Blocks (Digital, Dental, Peripheral, etc.) FAQ

Disclaimer

The 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 dmckenzie@acep.org.

Updated 05/05/2015

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