Expert Advice to Improve Coding Pain Blocks With or Without Guidance

When coding revisions are implemented, coders are always looking for the new steps they must follow to document properly and avoid denials. In 2023, the CPT code set underwent revisions to the somatic nerve injections codes regarding the reporting of image guidance, which changed the steps coders need to follow. Let's go over the new information and the steps coders should now take.

If the operative report documentation supports the use of image guidance with somatic nerve injection, the first step is to check your CPT code description to determine if imaging is included or can be captured separately. For example, the code description for 64415 was revised in 2023 to include image guidance. Its new description is as follows: 64415 — Injection(s), anesthetic agent(s) and/or steroid; branchial plexus, including image guidance, when performed

76942, 77002, or 77003 are no longer separately reported with CPT 64415.

In contrast, CPT code 64450 does not include image guidance within its code description: 64450 — Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch

76942, 77002, or 77003 may be reported separately with CPT 66450 if supported within documentation.

Coders will need to look further to determine the correct image guidance CPT to apply. This can be a challenge for coders when set guidance has been standardized for a long time, but coders must be flexible and able to change how they approach coding when the rules and results change. Per these revisions, image guidance is now included within the code description of CPT codes 64415-64417 and 64445-64448. This is further reiterated with a parenthetical note following each CPT (e.g., "Do not report 64415 in conjunction with 76942, 77002, 77003").

Exclusionary parenthetical notes have also been updated and follow CPT codes 76942, 77002, and 77003. These notes instruct coders when not to report image guidance with the somatic nerve injection. In its "CPT 2024 Professional Edition," AMA includes a table that can be referred to for a quick reference. The table — titled "Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic" — can be found on p. 489.

Whether you are flipping through the pages of the CPT codebook or using a software program, by keeping this information at your fingers, somatic nerve injection coding should be less of a pain.