Billing Guidelines For CPT 64450, CPT 64415 & CPT 64405
CPT 64450, CPT 64415 and CPT 64405 can be used to report injections anesthetic agent/agents and/or steroids to relieve pain.
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1. CPT 64405
CPT code 64405 is described by the CPT manual as: “Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve.”
1.1 Procedure
The goal of CPT 64405 is to report injections of an anesthetic and/or steroid agent into the greater occipital nerve of a patient.
When the patient is appropriately prepped, the provider uses a needle and syringe to administer one or more injections of an anesthetic agent and/or steroid close to the greater occipital nerve, which anesthetizes the area supplied by the nerve.
This procedure is also called an occipital nerve block. The provider performs this procedure to relieve occipital neuralgia, an intense nerve–related headache pain often due to trauma to the nerves at the back of the head, or cervicogenic headaches, which occur due to a problem in the cervical spine, the part of the neck near the base of the skull.
1.2 Billing Guidelines
This code can also be reported diagnostic purposes. Report CPT 64405 for one or more injections during the procedure.
2. CPT 64415
CPT code 64415 is described by the CPT manual as: “Injection(s), anesthetic agent(s) and/or steroid; brachial plexus.”
2.1 Procedure
The goal of the CPT 64415 procedure is to report injections of anesthetic and/or steroid agent into the brachial plexus of a patient.
When the patient is appropriately prepped, the provider uses a needle and syringe to administer one or more injections of an anesthetic agent, such as lidocaine or bupivacaine, and/or a steroid, based on the patient’s condition and various requirements for the surgery (for example, intensity of anesthesia required or how long the target site needs to remain anesthetized).
He pushes the needle into the brachial area, very close to the brachial nerve bunch, taking care not to injure the nerves directly with the needle, and injects the anesthetic agent and/or steroid.
The nerve block can be administered with any one of four approaches based on the point of injection: interscalene, supraclavicular, infraclavicular, or axillary.
It takes around 10 to 15 minutes after the injection for the entire arm to become anesthetized.
The provider examines the arm to decide whether all the superficial and deep structures are anesthetized completely.
Usually, the limb remains insensitive for a few hours even after the surgery; thus, the injection may act as part of postoperative pain management. Once the limb becomes completely numb due to the effect of the nerve block, it is ready for surgery to be performed.
2.2 Billing Guidelines
For a continuous infusion of an anesthetic and/or steroid into the brachial plexus via a catheter, see CPT 64416.
Report this code for one or more anesthetic and/or steroid agent injections during one procedure.
3. CPT 64450
CPT code 64450 is described by the CPT manual as: “Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch.”
3.1 Procedure
The goal of the CPT 64450 is to report injections an anesthetic agent, steroid (or both) close to a peripheral nerve or branch.
When the patient is appropriately prepped, the provider uses a needle and syringe to administer one or more injections of an anesthetic agent, steroid, or both close to a peripheral nerve or branch, which anesthetizes the area supplied by the nerve.
The provider then withdraws the needle and applies a bandage to the site. The provider performs this procedure to relieve pain or desensitize an area to be operated upon. She may also perform the procedure for diagnostic purposes.
3.2 Billing Guidelines
CPT 64450 represents a unilateral service, meaning the provider performs the procedure on one side. If the provider performs this procedure bilaterally, report it once with modifier 50, or report it twice, once with modifier RT and again with modifier LT, depending on each payer’s preference.
If the provider injects an anesthetic agent or steroid into the plantar common digital nerve, such as in Morton’s neuroma, use CPT 64455.
For injection, anesthetic agent, nerves innervating the sacroiliac joint, use CPT 64451 instead of this code.
