Peripheral nerve block

[Julie Thorne]

Recently I have been asked by my employer to evaluate and possibly implement a peripheral neuropathy program involving "nerve block" injections. I attended cadaver course and practiced a few true US guided blocks. I am curious if someone knowledgeable in these types of procedures is familiar with following recommended techniques and billing codes that have been proposed for me to use....

Procedure: patient prone, mark sural, superficial peroneal, and saphenous nerve, cleanse with betadine, inject 1mL of Marcaine using 27g 1.5in needle by inserting needle 1/2 way at 45 degree angle laterally, then almost withdraw- redirect to 45 degree other direction- 2mL per nerve. Cold laser therapy after injection. Do this 3x/week x 4 weeks!

CPT: 76942, j0670, a4450, 64450 (billed Each time 3x/week!)

I am concerned about the dx US code as well as frequency of nerve block code- is surgical tray code a normal thing to bill. Also, this does not appear to be a true block? As at a 45 degree 3/4 inch insertion- how is that truly a US guided block? Would you want to do that 3x/week?!?

Sorry this is so long- just not sure where to look for insight on a protocol like this?

Thanks,
Julie, FNP-BC

[Scott Nall]

Hey Julie, I think you were at my table at the course!  Good to hear from you.

I haven't heard of this protocol, but to me, it would only be a nerve block if you actually guided the needle next to the nerve a put a "halo" of local around it.  Now how efficacious this would be I have no idea.  As of right now I only use nerve blocks if I'm going to do something painful in the area that is blocked, ex. tibial nerve block before going after the plantar fascia.  It might be worth while to do something like what your talking about if you added Sarapin to the mix because it's supposed to have some neural calming affects.  We'll see if Grand Master Jonathan Fenton has any more advice for you.

[Jonathan Fenton]

Pure fraud! Once you're audited there will be re-payment, fines, interest, and possible jail (if Medicare).
Only thing to code is trigger point code, and even that's stretching it. Really its neural therapy or peri-neural injection, for which a nerve block code is inappropriate and fraudulent, as is the US code without perfect visualization of the needle and nerve with hard copy (digital) proof. This should really be charged to the patient, not the insurance carrier.
Whenever you do an injection you can bill for a tray A4450 but few pay for it.
Marcaine is myotoxic, chondrotoxic, and cardiotoxic so is dubious to use other than pure nerve blocks.
I'd worry about the ethics of your employer!!
JF

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Jonathan

[Julie Thorne]

Thank you Jonathan, I'm very grateful for your honest response and it reaffirms my EXACT concerns with this procedure. Are you familiar with any other- more legitimate treatments for peripheral neuropathy?

Thanks again!!

Julie 

[rkas...@gmail.com]

Can you code 76942 along with 64450 for carpal tunnel ultrasound guided injection?

RK, MD

[CLAN...@aol.com]

Yes you can bill the Ultrasound code with a peripheral nerve block. I believe a carpal tunnel block however has its own code 20526. If you use Ultrasound you need to save a copy of the picture to prove you used it and was next to the nerve in case of audit.

 

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