Local Coverage Article Billing and Coding

Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)

A56607

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Contractor Information

Article Information

General Information

Article ID
A56607
Article Title
Billing and Coding: Continuous Peripheral Nerve Blocks (CPNB)
Article Type
Billing and Coding
Original Effective Date
06/06/2019
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) states that no payment shall be made to any provider for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 23, §20.9 Anesthesia is included in surgical procedures

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Continuous Peripheral Nerve Blocks (CPNB) L37641.

Limitations

Reimbursement for the control or management of pain in the immediate postoperative period is bundled into the payment for the procedure, surgical or anesthetic - regardless of the method by which the care provider, including the anesthesiologist, decides to manage pain.

Coding Information

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
64416 Njx aa&/strd brch pl nfs img
64446 Njx aa&/strd sc nrv nfs img
64448 Njx aa&/strd fem nrv nfs img
64449 Njx aa&/strd lmbr plex nfs

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(600 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
B02.1 - B02.29 Zoster meningitis - Other postherpetic nervous system involvement
B02.7 - B02.9 Disseminated zoster - Zoster without complications
E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy
E08.44 Diabetes mellitus due to underlying condition with diabetic amyotrophy
E09.41 Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy
E09.44 Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy
E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy
E10.44 Type 1 diabetes mellitus with diabetic amyotrophy
E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy
E11.44 Type 2 diabetes mellitus with diabetic amyotrophy
E13.41 Other specified diabetes mellitus with diabetic mononeuropathy
E13.44 Other specified diabetes mellitus with diabetic amyotrophy
G50.0 Trigeminal neuralgia
G54.0 - G54.6 Brachial plexus disorders - Phantom limb syndrome with pain
G54.8 Other nerve root and plexus disorders
G55 - G59 Nerve root and plexus compressions in diseases classified elsewhere - Mononeuropathy in diseases classified elsewhere
G89.11 - G89.3 Acute pain due to trauma - Neoplasm related pain (acute) (chronic)
G90.50 - G90.59 Complex regional pain syndrome I, unspecified - Complex regional pain syndrome I of other specified site
I73.00 - I73.01 Raynaud's syndrome without gangrene - Raynaud's syndrome with gangrene
L74.510 - L74.519 Primary focal hyperhidrosis, axilla - Primary focal hyperhidrosis, unspecified
M25.511 - M25.519 Pain in right shoulder - Pain in unspecified shoulder
M25.551 - M25.569 Pain in right hip - Pain in unspecified knee
M25.59 Pain in other specified joint
M46.1 Sacroiliitis, not elsewhere classified
M50.10 - M50.13 Cervical disc disorder with radiculopathy, unspecified cervical region - Cervical disc disorder with radiculopathy, cervicothoracic region
M51.14 - M51.17 Intervertebral disc disorders with radiculopathy, thoracic region - Intervertebral disc disorders with radiculopathy, lumbosacral region
M53.3 Sacrococcygeal disorders, not elsewhere classified
M53.81 - M53.83 Other specified dorsopathies, occipito-atlanto-axial region - Other specified dorsopathies, cervicothoracic region
M54.10 - M54.81 Radiculopathy, site unspecified - Occipital neuralgia
M79.2 Neuralgia and neuritis, unspecified
M94.0 Chondrocostal junction syndrome [Tietze]
M96.1 Postlaminectomy syndrome, not elsewhere classified
R07.1 Chest pain on breathing
R07.81 Pleurodynia
R10.10 Upper abdominal pain, unspecified
R10.2 - R10.30 Pelvic and perineal pain - Lower abdominal pain, unspecified
R25.0 - R25.9 Abnormal head movements - Unspecified abnormal involuntary movements
R52 Pain, unspecified
R68.84 Jaw pain
S14.2XXA - S14.9XXS Injury of nerve root of cervical spine, initial encounter - Injury of unspecified nerves of neck, sequela
S24.2XXA - S24.9XXS Injury of nerve root of thoracic spine, initial encounter - Injury of unspecified nerve of thorax, sequela
S34.21XA - S34.22XS Injury of nerve root of lumbar spine, initial encounter - Injury of nerve root of sacral spine, sequela
S34.4XXA - S34.9XXS Injury of lumbosacral plexus, initial encounter - Injury of unspecified nerves at abdomen, lower back and pelvis level, sequela
S44.00XA - S44.92XS Injury of ulnar nerve at upper arm level, unspecified arm, initial encounter - Injury of unspecified nerve at shoulder and upper arm level, left arm, sequela
S54.00XA - S54.92XS Injury of ulnar nerve at forearm level, unspecified arm, initial encounter - Injury of unspecified nerve at forearm level, left arm, sequela
S64.00XA - S64.92XS Injury of ulnar nerve at wrist and hand level of unspecified arm, initial encounter - Injury of unspecified nerve at wrist and hand level of left arm, sequela
S74.00XA - S74.92XS Injury of sciatic nerve at hip and thigh level, unspecified leg, initial encounter - Injury of unspecified nerve at hip and thigh level, left leg, sequela
S84.00XA - S84.92XS Injury of tibial nerve at lower leg level, unspecified leg, initial encounter - Injury of unspecified nerve at lower leg level, left leg, sequela
S94.00XA - S94.92XS Injury of lateral plantar nerve, unspecified leg, initial encounter - Injury of unspecified nerve at ankle and foot level, left leg, sequela
Z48.3 Aftercare following surgery for neoplasm
Z48.89 Encounter for other specified surgical aftercare

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023 R6

Under CPT/HCPCS Codes Group 1: Codes the description was revised for 64416, 64446 and 64448. This revision is due to the 2023 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/23.

10/01/2021 R5

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added M54.50, M54.51 and M54.59. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/2021.

10/01/2020 R4

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added M25.59. This revision is due to the Annual ICD-10 Code Update and is effective on October 1, 2020.

01/01/2020 R3

Under CPT/HCPCS Codes Group 1: Codes the code descriptions were revised for CPT® codes 64416, 64446, 64448, and 64449. This revision is due to the Annual CPT®/HCPCS Code Update and becomes effective on 1/1/2020.

10/10/2019 R2

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Continuous Peripheral Nerve Blocks (CPNB) L37641 LCD and placed in this article.

06/06/2019 R1

All coding located in the Coding Information section has been removed from the related Continuous Peripheral Nerve Blocks (CPNB) L37641 LCD and added to this article.

Associated Documents

Related Local Coverage Documents
LCDs
L37641 - Continuous Peripheral Nerve Blocks (CPNB)
Related National Coverage Documents
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Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
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Public Versions
Updated On Effective Dates Status
01/05/2023 01/01/2023 - N/A Currently in Effect You are here
08/09/2021 10/01/2021 - 12/31/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Continuous Peripheral
  • Nerve Blocks
  • CPNB