cpt code and description
64450 - Injection, anesthetic agent; other peripheral nerve or branch - average fee amount - $80 - $100
64415 - Injection, anesthetic agent; brachial plexus, single Average fee amount - $110 - $130
Injections for Post-Operative Pain Control
When a patient is to receive an Injection or has a Catheter placed during an Arthroscopic Shoulder surgical procedure for control of post-operative pain, there are certain requirements which must be met in order to bill the injection/Catheterization procedure separately.
o Do not bill to Medicare.
o The Injection/Catheterization procedure must be performed by a different physician (usually the anesthesiologist) from the surgeon who performs the ortho.
scope surgery.
o There must be a separate Procedure Report for the Post-Op Injection/ Catheterization procedure (it cannot be part of the surgeon’s OP Report or part of the Anesthesia Record).
o The Block must not be the only anesthesia for the case.
o If there is a separate report for the Injection/Catheterization procedure and the Injection/Catheterization procedure was performed by a different physician, you may bill for the Injection/Catheterization procedure. Use a different claim form from the Shoulder surgery procedure and bill the Injection/Catheterization procedure claim in the name of the anesthesiologist (or other physician) who performed the Injection/Catheterization procedure.
o Codes for billing Injection/Catheterization Shoulder post-operative pain procedures:
1. 64415 – Brachial Plexus Block (also use this code for an Interscalene Block) for a Single Injection OR
2. 64416 – Brachial Plexus Infusion by Catheter using a Pain Pump Medicare has issued specific guidance that in most cases they consider Injections performed routinely for Post-Operative Pain Control to be bundled into the orthopedic surgeon’s global services (even when the Injection is performed by a different physician), so we would recommend not billing them to Medicare.
If Injections are given for Post-Op Pain Control after Knee Surgery, the 64447 code for a Femoral Nerve Block Injection or code 64448 for a Femoral Block by Catheter using a Pain Pump would be used. Use code 64450 for Blocks for Ankle and Foot procedures.
For example, when an avulsion of a nail plate (CPT code 11730) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 11730 when the same physician performs both procedures
For example, when a small joint or bursa arthrocentesis, aspiration and/or injection (CPT code 20600) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 20600 when the same physician performs both procedures.
We require supporting clinical documentation in the use of Modifier 59 for a group of select National Correct Coding Initiatives (NCCI) edits. The documentation should substantiate the use of Modifier 59 in requesting separate reimbursement. This documentation should be supplied with the initial claim. We are adding 49 code pairs to the existing list. The code pairs that are being added are:
Denied Code Paid Code
64415 00450 64416 01630 64445 01480 64448 01480
64415 01400 64416 01638 64447 01320 64450 01400
64415 01480 64416 01710 64447 01392 64450 01402
64415 01610 64416 01740 64447 01400 64450 01464
64415 01620 64416 01810 64447 01402 64450 01470
64415 01630 64416 01830 64447 01464 64450 01472
64415 01638 64445 01320 64447 01470 64450 01480
64415 01710 64445 01392 64447 01472 64450 01630
64415 01740 64445 01400 64447 01480 64450 01810
64415 01810 64445 01402 64448 01320 64450 01830
64415 01830 64445 01464 64448 01392
64416 00450 64445 01470 64448 01400
64416 01610 64445 01472 64448 01402
64450 - Injection, anesthetic agent; other peripheral nerve or branch - average fee amount - $80 - $100
64415 - Injection, anesthetic agent; brachial plexus, single Average fee amount - $110 - $130
Injections for Post-Operative Pain Control
When a patient is to receive an Injection or has a Catheter placed during an Arthroscopic Shoulder surgical procedure for control of post-operative pain, there are certain requirements which must be met in order to bill the injection/Catheterization procedure separately.
o Do not bill to Medicare.
o The Injection/Catheterization procedure must be performed by a different physician (usually the anesthesiologist) from the surgeon who performs the ortho.
scope surgery.
o There must be a separate Procedure Report for the Post-Op Injection/ Catheterization procedure (it cannot be part of the surgeon’s OP Report or part of the Anesthesia Record).
o The Block must not be the only anesthesia for the case.
o If there is a separate report for the Injection/Catheterization procedure and the Injection/Catheterization procedure was performed by a different physician, you may bill for the Injection/Catheterization procedure. Use a different claim form from the Shoulder surgery procedure and bill the Injection/Catheterization procedure claim in the name of the anesthesiologist (or other physician) who performed the Injection/Catheterization procedure.
o Codes for billing Injection/Catheterization Shoulder post-operative pain procedures:
1. 64415 – Brachial Plexus Block (also use this code for an Interscalene Block) for a Single Injection OR
2. 64416 – Brachial Plexus Infusion by Catheter using a Pain Pump Medicare has issued specific guidance that in most cases they consider Injections performed routinely for Post-Operative Pain Control to be bundled into the orthopedic surgeon’s global services (even when the Injection is performed by a different physician), so we would recommend not billing them to Medicare.
If Injections are given for Post-Op Pain Control after Knee Surgery, the 64447 code for a Femoral Nerve Block Injection or code 64448 for a Femoral Block by Catheter using a Pain Pump would be used. Use code 64450 for Blocks for Ankle and Foot procedures.
For example, when an avulsion of a nail plate (CPT code 11730) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 11730 when the same physician performs both procedures
For example, when a small joint or bursa arthrocentesis, aspiration and/or injection (CPT code 20600) is performed, anesthesia may be provided by the surgeon using a digital nerve block (CPT code 64450). Because this type of anesthesia provided by the surgeon performing the procedure is not separately payable, CPT code 64450 is bundled into CPT code 20600 when the same physician performs both procedures.
We require supporting clinical documentation in the use of Modifier 59 for a group of select National Correct Coding Initiatives (NCCI) edits. The documentation should substantiate the use of Modifier 59 in requesting separate reimbursement. This documentation should be supplied with the initial claim. We are adding 49 code pairs to the existing list. The code pairs that are being added are:
Denied Code Paid Code
64415 00450 64416 01630 64445 01480 64448 01480
64415 01400 64416 01638 64447 01320 64450 01400
64415 01480 64416 01710 64447 01392 64450 01402
64415 01610 64416 01740 64447 01400 64450 01464
64415 01620 64416 01810 64447 01402 64450 01470
64415 01630 64416 01830 64447 01464 64450 01472
64415 01638 64445 01320 64447 01470 64450 01480
64415 01710 64445 01392 64447 01472 64450 01630
64415 01740 64445 01400 64447 01480 64450 01810
64415 01810 64445 01402 64448 01320 64450 01830
64415 01830 64445 01464 64448 01392
64416 00450 64445 01470 64448 01400
64416 01610 64445 01472 64448 01402