Please note that for facilities, the edit can always be bypassed with a modifier when appropriate.Įxample 1: Physician CCI edits for 26055 show 64450 as being a component of 26055, and it is allowed to be bypassed with a modifier if appropriate (1 status)Ģ6055 – Tendon sheath incision (e.g., for trigger finger)Ħ4450 – Injection(s), anesthetic agent(s) and/or steroid other peripheral nerve or branchĮxample 2: Physician CCI edits for 23412 show 64415 as being a component of 23412, and it is NOT allowed to be bypassed with a modifier (0 status)Ģ3412 – Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open chronicĦ4415 – Injection(s), anesthetic agent(s) and/or steroid brachial plexus There is an exception to this if the block is done for post-surgical pain management, but please note that physician CMS Correct Coding Initiative (CCI) edits bundle many nerve block codes into surgical codes and do not allow for a modifier to bypass the edits (status 0 edits).Do NOT report a 644xx nerve block code when performed by the same provider who performed the surgical procedure since blocks are considered part of the surgical package (Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia) unless….Here are some tips to help guide your coding for nerve blocks: Providers must remember to be very clear to document that the block is for post-operative pain management, otherwise coders can’t assume that is the case and should not code the nerve block. You may wonder, “why isn’t the peripheral nerve block coded using 64450?” Nerve blocks are a necessary part of many surgical procedures for a total loss of feeling if needed for surgery and are often also used for post-operative pain relief, but if the block is not documented as being for post-operative pain management, then it is assumed to only be used for the surgery and therefore included in the surgical package and not coded separately. Sterile dressing applied.Ģ6055-F3 – Tendon sheath incision (e.g., for trigger finger) The finger was taken through range of motion and found not to trigger. Inflamed flexor tenosynovium excised sharply with scissors. The digital bundles on both sides were identified and protected throughout the case. Incision taken through subcutaneous tissues and palmar fascia. Transverse incision made in line with ring finger. Extremity exsanguinated using Esmarch bandage. He was prepped and draped in usual sterile fashion. A peripheral nerve block given consisting of 5 cc of 1% lidocaine with epinephrine and 0.25% Marcaine plain as a digital block for pain control and vasoconstriction.
Brought to the OR table, positioned supine. What CPT-4 code(s) should be assigned for this procedure?ĭESCRIPTION OF PROCEDURE: The patient was identified in preoperative holding area. We’ll repeat the example and provide the answer. We recently presented a CPT-4 coding challenge with an example of a trigger finger release. Answer: CPT-4 coding challenge: Coding nerve blocks 64400-64455
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