Draft Local Coverage Article Billing and Coding

Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

DA52725

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Source Article ID
A52725
Draft Article ID
DA52725
Draft Article Title
Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
Article Type
Billing and Coding
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CMS National Coverage Policy

N/A

Article Guidance

Article Text

The following billing and coding guidance is to be used with its associated Local Coverage Determination.

LCD L35457 states, "Nerve blockade and/or electrical stimulation are non-covered for the treatment of metabolic peripheral neuropathy. The peer-reviewed medical literature has not demonstrated the efficacy or clinical utility of nerve blockade or electrical stimulation, alone or used together, in the diagnosis and/or treatment of neuropathic pain."

The use of peripheral nerve blocks for treating diabetic neuropathy is not considered reasonable and/or necessary and is not covered by Medicare Part A or B. Such use of peripheral nerve blocks is not supported by the current peer reviewed, published, evidence based scientific literature nor by specialty society guidelines. Claims are subject to review and recoupment.

This notification does not affect those regional/local blocks done as part of an operative procedure (for example wound debridement in the operating room) when performed as an adjunct to or the sole means of regional/local anesthesia for the procedure.

For somatic nerve blocks, it is inappropriate to bill for fluoroscopy (CPT® codes 77002 or 77003) with a 59 modifier when the procedure(s) billed on that date of service for the same patient by the same provider are included in the CPT® description of the procedure(s) performed.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician or non-physician practitioner responsible for and providing the care of the patient.
  3. The submitted medical record should support the use of the selected diagnosis code(s). The submitted CPT/HCPCS code should describe the service performed. 

Sources:

  1. Neurology 2011;76;1758; V. Bril, J. England, G.M. Franklin, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Neurodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation This information is current as of February 7, 2013
  2. American Family Physician 2010;82(2):151-158 T. Lindsay, B. Rodgers, V. Savath, K. Hettinger Treating Diabetic Peripheral Neuropathic Pain

Coding Information

CPT/HCPCS Codes

Group 1

(31 Codes)
Group 1 Paragraph

Effective 01/01/2020, 64999 is to be used to report injections of anesthetic and/or steroids for the facial and phrenic nerves and cervical plexus. This code replaces the deleted codes 64402, 64410 and 64413.

Group 1 Codes
CodeDescription
62281 INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR WITHOUT OTHER THERAPEUTIC SUBSTANCE; EPIDURAL, CERVICAL OR THORACIC
62324 INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE
62325 INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE
64408 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; VAGUS NERVE
64415 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS
64417 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE
64418 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE
64420 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, SINGLE LEVEL
64421 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64425 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES
64430 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PUDENDAL NERVE
64435 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PARACERVICAL (UTERINE) NERVE
64445 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE
64446 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64447 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE
64448 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64449 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; LUMBAR PLEXUS, POSTERIOR APPROACH, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64450 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH
64451 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED TOMOGRAPHY)
64461 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
64462 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SECOND AND ANY ADDITIONAL INJECTION SITE(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64463 PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; CONTINUOUS INFUSION BY CATHETER (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
64505 INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
64510 INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
64517 INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS
64520 INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)
64530 INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING
64620 DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
64999 UNLISTED PROCEDURE, NERVOUS SYSTEM

Group 2

(9 Codes)
Group 2 Paragraph

CPT code 64450 is NOT medically necessary when billed with any other CPT code in the GROUP 2 Codes listed PLUS any one of the GROUP 1 diagnosis listed in the ICD-10 Codes that DO NOT Support Medical Necessity section below.

Group 2 Codes
CodeDescription
64450 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH
76881 ULTRASOUND, COMPLETE JOINT (IE, JOINT SPACE AND PERI-ARTICULAR SOFT-TISSUE STRUCTURES), REAL-TIME WITH IMAGE DOCUMENTATION
76882 ULTRASOUND, LIMITED, JOINT OR OTHER NONVASCULAR EXTREMITY STRUCTURE(S) (EG, JOINT SPACE, PERI-ARTICULAR TENDON[S], MUSCLE[S], NERVE[S], OTHER SOFT-TISSUE STRUCTURE[S], OR SOFT-TISSUE MASS[ES]), REAL-TIME WITH IMAGE DOCUMENTATION
76942 ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION
76999 UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES
97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
G0282 ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBED IN G0281
G0283 ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(495 Codes)
Group 1 Paragraph

The following list of ICD-10-CM codes support medical necessity for all Group 1 CPT codes listed in this LCD (Somatic & epidural nerve block procedures). These diagnoses must be supported by appropriate documentation of medical necessity in the medical record. These are the only covered diagnosis for Group 1 CPTs:

Group 1 Codes
CodeDescription
B02.0 Zoster encephalitis
B02.1 Zoster meningitis
B02.21 Postherpetic geniculate ganglionitis
B02.22 Postherpetic trigeminal neuralgia
B02.23 Postherpetic polyneuropathy
B02.24 Postherpetic myelitis
B02.29 Other postherpetic nervous system involvement
B02.7 Disseminated zoster
B02.8 Zoster with other complications
B02.9 Zoster without complications
G50.0 Trigeminal neuralgia
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G54.5 Neuralgic amyotrophy
G54.6 Phantom limb syndrome with pain
G54.8 Other nerve root and plexus disorders
G55 Nerve root and plexus compressions in diseases classified elsewhere
G56.11 Other lesions of median nerve, right upper limb
G56.12 Other lesions of median nerve, left upper limb
G56.13 Other lesions of median nerve, bilateral upper limbs
G56.21 Lesion of ulnar nerve, right upper limb
G56.22 Lesion of ulnar nerve, left upper limb
G56.23 Lesion of ulnar nerve, bilateral upper limbs
G56.31 Lesion of radial nerve, right upper limb
G56.32 Lesion of radial nerve, left upper limb
G56.33 Lesion of radial nerve, bilateral upper limbs
G56.41 Causalgia of right upper limb
G56.42 Causalgia of left upper limb
G56.43 Causalgia of bilateral upper limbs
G56.81 Other specified mononeuropathies of right upper limb
G56.82 Other specified mononeuropathies of left upper limb
G56.91 Unspecified mononeuropathy of right upper limb
G56.92 Unspecified mononeuropathy of left upper limb
G57.01 Lesion of sciatic nerve, right lower limb
G57.02 Lesion of sciatic nerve, left lower limb
G57.03 Lesion of sciatic nerve, bilateral lower limbs
G57.11 Meralgia paresthetica, right lower limb
G57.12 Meralgia paresthetica, left lower limb
G57.13 Meralgia paresthetica, bilateral lower limbs
G57.21 Lesion of femoral nerve, right lower limb
G57.22 Lesion of femoral nerve, left lower limb
G57.23 Lesion of femoral nerve, bilateral lower limbs
G57.31 Lesion of lateral popliteal nerve, right lower limb
G57.32 Lesion of lateral popliteal nerve, left lower limb
G57.33 Lesion of lateral popliteal nerve, bilateral lower limbs
G57.41 Lesion of medial popliteal nerve, right lower limb
G57.42 Lesion of medial popliteal nerve, left lower limb
G57.43 Lesion of medial popliteal nerve, bilateral lower limbs
G57.71 Causalgia of right lower limb
G57.72 Causalgia of left lower limb
G57.73 Causalgia of bilateral lower limbs
G57.81 Other specified mononeuropathies of right lower limb
G57.82 Other specified mononeuropathies of left lower limb
G57.91* Unspecified mononeuropathy of right lower limb
G57.92* Unspecified mononeuropathy of left lower limb
G58.0 Intercostal neuropathy
G58.7* Mononeuritis multiplex
G58.8* Other specified mononeuropathies
G58.9* Mononeuropathy, unspecified
G59* Mononeuropathy in diseases classified elsewhere
G89.11 Acute pain due to trauma
G89.12 Acute post-thoracotomy pain
G89.18 Other acute postprocedural pain
G89.21 Chronic pain due to trauma
G89.22 Chronic post-thoracotomy pain
G89.28 Other chronic postprocedural pain
G89.3 Neoplasm related pain (acute) (chronic)
G90.50 Complex regional pain syndrome I, unspecified
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.59 Complex regional pain syndrome I of other specified site
I73.00 Raynaud's syndrome without gangrene
I73.01 Raynaud's syndrome with gangrene
L74.510 Primary focal hyperhidrosis, axilla
L74.511 Primary focal hyperhidrosis, face
L74.512 Primary focal hyperhidrosis, palms
L74.513 Primary focal hyperhidrosis, soles
M25.511 Pain in right shoulder
M25.512 Pain in left shoulder
M25.551 Pain in right hip
M25.552 Pain in left hip
M25.561 Pain in right knee
M25.562 Pain in left knee
M43.27 Fusion of spine, lumbosacral region
M43.28 Fusion of spine, sacral and sacrococcygeal region
M46.1 Sacroiliitis, not elsewhere classified
M48.01 Spinal stenosis, occipito-atlanto-axial region
M48.02 Spinal stenosis, cervical region
M48.03 Spinal stenosis, cervicothoracic region
M48.04 Spinal stenosis, thoracic region
M48.05 Spinal stenosis, thoracolumbar region
M48.062 Spinal stenosis, lumbar region with neurogenic claudication
M50.11 Cervical disc disorder with radiculopathy, high cervical region
M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
M50.13 Cervical disc disorder with radiculopathy, cervicothoracic region
M50.21 Other cervical disc displacement, high cervical region
M50.221 Other cervical disc displacement at C4-C5 level
M50.222 Other cervical disc displacement at C5-C6 level
M50.223 Other cervical disc displacement at C6-C7 level
M50.23 Other cervical disc displacement, cervicothoracic region
M50.31 Other cervical disc degeneration, high cervical region
M50.321 Other cervical disc degeneration at C4-C5 level
M50.322 Other cervical disc degeneration at C5-C6 level
M50.323 Other cervical disc degeneration at C6-C7 level
M50.33 Other cervical disc degeneration, cervicothoracic region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.24 Other intervertebral disc displacement, thoracic region
M51.25 Other intervertebral disc displacement, thoracolumbar region
M51.34 Other intervertebral disc degeneration, thoracic region
M51.35 Other intervertebral disc degeneration, thoracolumbar region
M53.0 Cervicocranial syndrome
M53.2X7 Spinal instabilities, lumbosacral region
M53.2X8 Spinal instabilities, sacral and sacrococcygeal region
M53.3 Sacrococcygeal disorders, not elsewhere classified
M53.81 Other specified dorsopathies, occipito-atlanto-axial region
M53.82 Other specified dorsopathies, cervical region
M53.83 Other specified dorsopathies, cervicothoracic region
M53.86 Other specified dorsopathies, lumbar region
M53.87 Other specified dorsopathies, lumbosacral region
M53.88 Other specified dorsopathies, sacral and sacrococcygeal region
M54.10* Radiculopathy, site unspecified
M54.11 Radiculopathy, occipito-atlanto-axial region
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.2 Cervicalgia
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M54.51 Vertebrogenic low back pain
M54.59 Other low back pain
M54.6 Pain in thoracic spine
M54.81 Occipital neuralgia
M79.2* Neuralgia and neuritis, unspecified
M94.0 Chondrocostal junction syndrome [Tietze]
M96.1 Postlaminectomy syndrome, not elsewhere classified
M99.20 Subluxation stenosis of neural canal of head region
M99.21 Subluxation stenosis of neural canal of cervical region
M99.22 Subluxation stenosis of neural canal of thoracic region
M99.30 Osseous stenosis of neural canal of head region
M99.31 Osseous stenosis of neural canal of cervical region
M99.32 Osseous stenosis of neural canal of thoracic region
M99.40 Connective tissue stenosis of neural canal of head region
M99.41 Connective tissue stenosis of neural canal of cervical region
M99.42 Connective tissue stenosis of neural canal of thoracic region
M99.50 Intervertebral disc stenosis of neural canal of head region
M99.51 Intervertebral disc stenosis of neural canal of cervical region
M99.52 Intervertebral disc stenosis of neural canal of thoracic region
M99.60 Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61 Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.62 Osseous and subluxation stenosis of intervertebral foramina of thoracic region
M99.70 Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71 Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.72 Connective tissue and disc stenosis of intervertebral foramina of thoracic region
R07.1 Chest pain on breathing
R07.81 Pleurodynia
R07.9* Chest pain, unspecified
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R25.0 Abnormal head movements
R25.1 Tremor, unspecified
R25.2 Cramp and spasm
R25.3 Fasciculation
R25.8 Other abnormal involuntary movements
R25.9 Unspecified abnormal involuntary movements
R44.0 Auditory hallucinations
R44.2 Other hallucinations
R44.3 Hallucinations, unspecified
R68.84 Jaw pain
S14.2XXA Injury of nerve root of cervical spine, initial encounter
S14.2XXD Injury of nerve root of cervical spine, subsequent encounter
S14.2XXS Injury of nerve root of cervical spine, sequela
S14.3XXA Injury of brachial plexus, initial encounter
S14.3XXD Injury of brachial plexus, subsequent encounter
S14.3XXS Injury of brachial plexus, sequela
S14.4XXA Injury of peripheral nerves of neck, initial encounter
S14.4XXD Injury of peripheral nerves of neck, subsequent encounter
S14.4XXS Injury of peripheral nerves of neck, sequela
S14.5XXA Injury of cervical sympathetic nerves, initial encounter
S14.5XXD Injury of cervical sympathetic nerves, subsequent encounter
S14.5XXS Injury of cervical sympathetic nerves, sequela
S14.8XXA Injury of other specified nerves of neck, initial encounter
S14.8XXD Injury of other specified nerves of neck, subsequent encounter
S14.8XXS Injury of other specified nerves of neck, sequela
S14.9XXA Injury of unspecified nerves of neck, initial encounter
S14.9XXD Injury of unspecified nerves of neck, subsequent encounter
S14.9XXS Injury of unspecified nerves of neck, sequela
S24.2XXA Injury of nerve root of thoracic spine, initial encounter
S24.2XXD Injury of nerve root of thoracic spine, subsequent encounter
S24.2XXS Injury of nerve root of thoracic spine, sequela
S24.3XXA Injury of peripheral nerves of thorax, initial encounter
S24.3XXD Injury of peripheral nerves of thorax, subsequent encounter
S24.3XXS Injury of peripheral nerves of thorax, sequela
S24.4XXA Injury of thoracic sympathetic nervous system, initial encounter
S24.4XXD Injury of thoracic sympathetic nervous system, subsequent encounter
S24.4XXS Injury of thoracic sympathetic nervous system, sequela
S24.8XXA Injury of other specified nerves of thorax, initial encounter
S24.8XXD Injury of other specified nerves of thorax, subsequent encounter
S24.8XXS Injury of other specified nerves of thorax, sequela
S24.9XXA Injury of unspecified nerve of thorax, initial encounter
S24.9XXD Injury of unspecified nerve of thorax, subsequent encounter
S24.9XXS Injury of unspecified nerve of thorax, sequela
S34.21XA Injury of nerve root of lumbar spine, initial encounter
S34.21XD Injury of nerve root of lumbar spine, subsequent encounter
S34.21XS Injury of nerve root of lumbar spine, sequela
S34.22XA Injury of nerve root of sacral spine, initial encounter
S34.22XD Injury of nerve root of sacral spine, subsequent encounter
S34.22XS Injury of nerve root of sacral spine, sequela
S34.4XXA Injury of lumbosacral plexus, initial encounter
S34.4XXD Injury of lumbosacral plexus, subsequent encounter
S34.4XXS Injury of lumbosacral plexus, sequela
S34.5XXA Injury of lumbar, sacral and pelvic sympathetic nerves, initial encounter
S34.5XXD Injury of lumbar, sacral and pelvic sympathetic nerves, subsequent encounter
S34.5XXS Injury of lumbar, sacral and pelvic sympathetic nerves, sequela
S34.6XXA Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, initial encounter
S34.6XXD Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, subsequent encounter
S34.6XXS Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, sequela
S34.8XXA Injury of other nerves at abdomen, lower back and pelvis level, initial encounter
S34.8XXD Injury of other nerves at abdomen, lower back and pelvis level, subsequent encounter
S34.8XXS Injury of other nerves at abdomen, lower back and pelvis level, sequela
S34.9XXA Injury of unspecified nerves at abdomen, lower back and pelvis level, initial encounter
S34.9XXD Injury of unspecified nerves at abdomen, lower back and pelvis level, subsequent encounter
S34.9XXS Injury of unspecified nerves at abdomen, lower back and pelvis level, sequela
S44.01XA Injury of ulnar nerve at upper arm level, right arm, initial encounter
S44.01XD Injury of ulnar nerve at upper arm level, right arm, subsequent encounter
S44.01XS Injury of ulnar nerve at upper arm level, right arm, sequela
S44.02XA Injury of ulnar nerve at upper arm level, left arm, initial encounter
S44.02XD Injury of ulnar nerve at upper arm level, left arm, subsequent encounter
S44.02XS Injury of ulnar nerve at upper arm level, left arm, sequela
S44.11XA Injury of median nerve at upper arm level, right arm, initial encounter
S44.11XD Injury of median nerve at upper arm level, right arm, subsequent encounter
S44.11XS Injury of median nerve at upper arm level, right arm, sequela
S44.12XA Injury of median nerve at upper arm level, left arm, initial encounter
S44.12XD Injury of median nerve at upper arm level, left arm, subsequent encounter
S44.12XS Injury of median nerve at upper arm level, left arm, sequela
S44.21XA Injury of radial nerve at upper arm level, right arm, initial encounter
S44.21XD Injury of radial nerve at upper arm level, right arm, subsequent encounter
S44.21XS Injury of radial nerve at upper arm level, right arm, sequela
S44.22XA Injury of radial nerve at upper arm level, left arm, initial encounter
S44.22XD Injury of radial nerve at upper arm level, left arm, subsequent encounter
S44.22XS Injury of radial nerve at upper arm level, left arm, sequela
S44.30XA Injury of axillary nerve, unspecified arm, initial encounter
S44.30XD Injury of axillary nerve, unspecified arm, subsequent encounter
S44.30XS Injury of axillary nerve, unspecified arm, sequela
S44.31XA Injury of axillary nerve, right arm, initial encounter
S44.31XD Injury of axillary nerve, right arm, subsequent encounter
S44.31XS Injury of axillary nerve, right arm, sequela
S44.32XA Injury of axillary nerve, left arm, initial encounter
S44.32XD Injury of axillary nerve, left arm, subsequent encounter
S44.32XS Injury of axillary nerve, left arm, sequela
S44.41XA Injury of musculocutaneous nerve, right arm, initial encounter
S44.41XD Injury of musculocutaneous nerve, right arm, subsequent encounter
S44.41XS Injury of musculocutaneous nerve, right arm, sequela
S44.42XA Injury of musculocutaneous nerve, left arm, initial encounter
S44.42XD Injury of musculocutaneous nerve, left arm, subsequent encounter
S44.42XS Injury of musculocutaneous nerve, left arm, sequela
S44.51XA Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, initial encounter
S44.51XD Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, subsequent encounter
S44.51XS Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, sequela
S44.52XA Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, initial encounter
S44.52XD Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, subsequent encounter
S44.52XS Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, sequela
S44.8X1A Injury of other nerves at shoulder and upper arm level, right arm, initial encounter
S44.8X1D Injury of other nerves at shoulder and upper arm level, right arm, subsequent encounter
S44.8X1S Injury of other nerves at shoulder and upper arm level, right arm, sequela
S44.8X2A Injury of other nerves at shoulder and upper arm level, left arm, initial encounter
S44.8X2D Injury of other nerves at shoulder and upper arm level, left arm, subsequent encounter
S44.8X2S Injury of other nerves at shoulder and upper arm level, left arm, sequela
S44.91XA Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter
S44.91XD Injury of unspecified nerve at shoulder and upper arm level, right arm, subsequent encounter
S44.91XS Injury of unspecified nerve at shoulder and upper arm level, right arm, sequela
S44.92XA Injury of unspecified nerve at shoulder and upper arm level, left arm, initial encounter
S44.92XD Injury of unspecified nerve at shoulder and upper arm level, left arm, subsequent encounter
S44.92XS Injury of unspecified nerve at shoulder and upper arm level, left arm, sequela
S54.01XA Injury of ulnar nerve at forearm level, right arm, initial encounter
S54.01XD Injury of ulnar nerve at forearm level, right arm, subsequent encounter
S54.01XS Injury of ulnar nerve at forearm level, right arm, sequela
S54.02XA Injury of ulnar nerve at forearm level, left arm, initial encounter
S54.02XD Injury of ulnar nerve at forearm level, left arm, subsequent encounter
S54.02XS Injury of ulnar nerve at forearm level, left arm, sequela
S54.11XA Injury of median nerve at forearm level, right arm, initial encounter
S54.11XD Injury of median nerve at forearm level, right arm, subsequent encounter
S54.11XS Injury of median nerve at forearm level, right arm, sequela
S54.12XA Injury of median nerve at forearm level, left arm, initial encounter
S54.12XD Injury of median nerve at forearm level, left arm, subsequent encounter
S54.12XS Injury of median nerve at forearm level, left arm, sequela
S54.21XA Injury of radial nerve at forearm level, right arm, initial encounter
S54.21XD Injury of radial nerve at forearm level, right arm, subsequent encounter
S54.21XS Injury of radial nerve at forearm level, right arm, sequela
S54.22XA Injury of radial nerve at forearm level, left arm, initial encounter
S54.22XD Injury of radial nerve at forearm level, left arm, subsequent encounter
S54.22XS Injury of radial nerve at forearm level, left arm, sequela
S54.31XA Injury of cutaneous sensory nerve at forearm level, right arm, initial encounter
S54.31XD Injury of cutaneous sensory nerve at forearm level, right arm, subsequent encounter
S54.31XS Injury of cutaneous sensory nerve at forearm level, right arm, sequela
S54.32XA Injury of cutaneous sensory nerve at forearm level, left arm, initial encounter
S54.32XD Injury of cutaneous sensory nerve at forearm level, left arm, subsequent encounter
S54.32XS Injury of cutaneous sensory nerve at forearm level, left arm, sequela
S54.8X1A Injury of other nerves at forearm level, right arm, initial encounter
S54.8X1D Injury of other nerves at forearm level, right arm, subsequent encounter
S54.8X1S Injury of other nerves at forearm level, right arm, sequela
S54.8X2A Injury of other nerves at forearm level, left arm, initial encounter
S54.8X2D Injury of other nerves at forearm level, left arm, subsequent encounter
S54.8X2S Injury of other nerves at forearm level, left arm, sequela
S54.91XA Injury of unspecified nerve at forearm level, right arm, initial encounter
S54.91XD Injury of unspecified nerve at forearm level, right arm, subsequent encounter
S54.91XS Injury of unspecified nerve at forearm level, right arm, sequela
S54.92XA Injury of unspecified nerve at forearm level, left arm, initial encounter
S54.92XD Injury of unspecified nerve at forearm level, left arm, subsequent encounter
S54.92XS Injury of unspecified nerve at forearm level, left arm, sequela
S64.01XA Injury of ulnar nerve at wrist and hand level of right arm, initial encounter
S64.01XD Injury of ulnar nerve at wrist and hand level of right arm, subsequent encounter
S64.01XS Injury of ulnar nerve at wrist and hand level of right arm, sequela
S64.02XA Injury of ulnar nerve at wrist and hand level of left arm, initial encounter
S64.02XD Injury of ulnar nerve at wrist and hand level of left arm, subsequent encounter
S64.02XS Injury of ulnar nerve at wrist and hand level of left arm, sequela
S64.11XA Injury of median nerve at wrist and hand level of right arm, initial encounter
S64.11XD Injury of median nerve at wrist and hand level of right arm, subsequent encounter
S64.11XS Injury of median nerve at wrist and hand level of right arm, sequela
S64.12XA Injury of median nerve at wrist and hand level of left arm, initial encounter
S64.12XD Injury of median nerve at wrist and hand level of left arm, subsequent encounter
S64.12XS Injury of median nerve at wrist and hand level of left arm, sequela
S64.21XA Injury of radial nerve at wrist and hand level of right arm, initial encounter
S64.21XD Injury of radial nerve at wrist and hand level of right arm, subsequent encounter
S64.21XS Injury of radial nerve at wrist and hand level of right arm, sequela
S64.22XA Injury of radial nerve at wrist and hand level of left arm, initial encounter
S64.22XD Injury of radial nerve at wrist and hand level of left arm, subsequent encounter
S64.22XS Injury of radial nerve at wrist and hand level of left arm, sequela
S64.31XA Injury of digital nerve of right thumb, initial encounter
S64.31XD Injury of digital nerve of right thumb, subsequent encounter
S64.31XS Injury of digital nerve of right thumb, sequela
S64.32XA Injury of digital nerve of left thumb, initial encounter
S64.32XD Injury of digital nerve of left thumb, subsequent encounter
S64.32XS Injury of digital nerve of left thumb, sequela
S64.490A Injury of digital nerve of right index finger, initial encounter
S64.490D Injury of digital nerve of right index finger, subsequent encounter
S64.490S Injury of digital nerve of right index finger, sequela
S64.491A Injury of digital nerve of left index finger, initial encounter
S64.491D Injury of digital nerve of left index finger, subsequent encounter
S64.491S Injury of digital nerve of left index finger, sequela
S64.492A Injury of digital nerve of right middle finger, initial encounter
S64.492D Injury of digital nerve of right middle finger, subsequent encounter
S64.492S Injury of digital nerve of right middle finger, sequela
S64.493A Injury of digital nerve of left middle finger, initial encounter
S64.493D Injury of digital nerve of left middle finger, subsequent encounter
S64.493S Injury of digital nerve of left middle finger, sequela
S64.494A Injury of digital nerve of right ring finger, initial encounter
S64.494D Injury of digital nerve of right ring finger, subsequent encounter
S64.494S Injury of digital nerve of right ring finger, sequela
S64.495A Injury of digital nerve of left ring finger, initial encounter
S64.495D Injury of digital nerve of left ring finger, subsequent encounter
S64.495S Injury of digital nerve of left ring finger, sequela
S64.496A Injury of digital nerve of right little finger, initial encounter
S64.496D Injury of digital nerve of right little finger, subsequent encounter
S64.496S Injury of digital nerve of right little finger, sequela
S64.497A Injury of digital nerve of left little finger, initial encounter
S64.497D Injury of digital nerve of left little finger, subsequent encounter
S64.497S Injury of digital nerve of left little finger, sequela
S64.498A Injury of digital nerve of other finger, initial encounter
S64.498D Injury of digital nerve of other finger, subsequent encounter
S64.498S Injury of digital nerve of other finger, sequela
S64.8X1A Injury of other nerves at wrist and hand level of right arm, initial encounter
S64.8X1D Injury of other nerves at wrist and hand level of right arm, subsequent encounter
S64.8X1S Injury of other nerves at wrist and hand level of right arm, sequela
S64.8X2A Injury of other nerves at wrist and hand level of left arm, initial encounter
S64.8X2D Injury of other nerves at wrist and hand level of left arm, subsequent encounter
S64.8X2S Injury of other nerves at wrist and hand level of left arm, sequela
S64.91XA Injury of unspecified nerve at wrist and hand level of right arm, initial encounter
S64.91XD Injury of unspecified nerve at wrist and hand level of right arm, subsequent encounter
S64.91XS Injury of unspecified nerve at wrist and hand level of right arm, sequela
S64.92XA Injury of unspecified nerve at wrist and hand level of left arm, initial encounter
S64.92XD Injury of unspecified nerve at wrist and hand level of left arm, subsequent encounter
S64.92XS Injury of unspecified nerve at wrist and hand level of left arm, sequela
S74.01XA Injury of sciatic nerve at hip and thigh level, right leg, initial encounter
S74.01XD Injury of sciatic nerve at hip and thigh level, right leg, subsequent encounter
S74.01XS Injury of sciatic nerve at hip and thigh level, right leg, sequela
S74.02XA Injury of sciatic nerve at hip and thigh level, left leg, initial encounter
S74.02XD Injury of sciatic nerve at hip and thigh level, left leg, subsequent encounter
S74.02XS Injury of sciatic nerve at hip and thigh level, left leg, sequela
S74.11XA Injury of femoral nerve at hip and thigh level, right leg, initial encounter
S74.11XD Injury of femoral nerve at hip and thigh level, right leg, subsequent encounter
S74.11XS Injury of femoral nerve at hip and thigh level, right leg, sequela
S74.12XA Injury of femoral nerve at hip and thigh level, left leg, initial encounter
S74.12XD Injury of femoral nerve at hip and thigh level, left leg, subsequent encounter
S74.12XS Injury of femoral nerve at hip and thigh level, left leg, sequela
S74.21XA Injury of cutaneous sensory nerve at hip and high level, right leg, initial encounter
S74.21XD Injury of cutaneous sensory nerve at hip and high level, right leg, subsequent encounter
S74.21XS Injury of cutaneous sensory nerve at hip and high level, right leg, sequela
S74.22XA Injury of cutaneous sensory nerve at hip and thigh level, left leg, initial encounter
S74.22XD Injury of cutaneous sensory nerve at hip and thigh level, left leg, subsequent encounter
S74.22XS Injury of cutaneous sensory nerve at hip and thigh level, left leg, sequela
S74.8X1A Injury of other nerves at hip and thigh level, right leg, initial encounter
S74.8X1D Injury of other nerves at hip and thigh level, right leg, subsequent encounter
S74.8X1S Injury of other nerves at hip and thigh level, right leg, sequela
S74.8X2A Injury of other nerves at hip and thigh level, left leg, initial encounter
S74.8X2D Injury of other nerves at hip and thigh level, left leg, subsequent encounter
S74.8X2S Injury of other nerves at hip and thigh level, left leg, sequela
S74.91XA Injury of unspecified nerve at hip and thigh level, right leg, initial encounter
S74.91XD Injury of unspecified nerve at hip and thigh level, right leg, subsequent encounter
S74.91XS Injury of unspecified nerve at hip and thigh level, right leg, sequela
S74.92XA Injury of unspecified nerve at hip and thigh level, left leg, initial encounter
S74.92XD Injury of unspecified nerve at hip and thigh level, left leg, subsequent encounter
S74.92XS Injury of unspecified nerve at hip and thigh level, left leg, sequela
S84.01XA Injury of tibial nerve at lower leg level, right leg, initial encounter
S84.01XD Injury of tibial nerve at lower leg level, right leg, subsequent encounter
S84.01XS Injury of tibial nerve at lower leg level, right leg, sequela
S84.02XA Injury of tibial nerve at lower leg level, left leg, initial encounter
S84.02XD Injury of tibial nerve at lower leg level, left leg, subsequent encounter
S84.02XS Injury of tibial nerve at lower leg level, left leg, sequela
S84.11XA Injury of peroneal nerve at lower leg level, right leg, initial encounter
S84.11XD Injury of peroneal nerve at lower leg level, right leg, subsequent encounter
S84.11XS Injury of peroneal nerve at lower leg level, right leg, sequela
S84.12XA Injury of peroneal nerve at lower leg level, left leg, initial encounter
S84.12XD Injury of peroneal nerve at lower leg level, left leg, subsequent encounter
S84.12XS Injury of peroneal nerve at lower leg level, left leg, sequela
S84.21XA Injury of cutaneous sensory nerve at lower leg level, right leg, initial encounter
S84.21XD Injury of cutaneous sensory nerve at lower leg level, right leg, subsequent encounter
S84.21XS Injury of cutaneous sensory nerve at lower leg level, right leg, sequela
S84.22XA Injury of cutaneous sensory nerve at lower leg level, left leg, initial encounter
S84.22XD Injury of cutaneous sensory nerve at lower leg level, left leg, subsequent encounter
S84.22XS Injury of cutaneous sensory nerve at lower leg level, left leg, sequela
S84.801A Injury of other nerves at lower leg level, right leg, initial encounter
S84.801D Injury of other nerves at lower leg level, right leg, subsequent encounter
S84.801S Injury of other nerves at lower leg level, right leg, sequela
S84.802A Injury of other nerves at lower leg level, left leg, initial encounter
S84.802D Injury of other nerves at lower leg level, left leg, subsequent encounter
S84.802S Injury of other nerves at lower leg level, left leg, sequela
S84.91XA Injury of unspecified nerve at lower leg level, right leg, initial encounter
S84.91XD Injury of unspecified nerve at lower leg level, right leg, subsequent encounter
S84.91XS Injury of unspecified nerve at lower leg level, right leg, sequela
S84.92XA Injury of unspecified nerve at lower leg level, left leg, initial encounter
S84.92XD Injury of unspecified nerve at lower leg level, left leg, subsequent encounter
S84.92XS Injury of unspecified nerve at lower leg level, left leg, sequela
S94.01XA Injury of lateral plantar nerve, right leg, initial encounter
S94.01XD Injury of lateral plantar nerve, right leg, subsequent encounter
S94.01XS Injury of lateral plantar nerve, right leg, sequela
S94.02XA Injury of lateral plantar nerve, left leg, initial encounter
S94.02XD Injury of lateral plantar nerve, left leg, subsequent encounter
S94.02XS Injury of lateral plantar nerve, left leg, sequela
S94.11XA Injury of medial plantar nerve, right leg, initial encounter
S94.11XD Injury of medial plantar nerve, right leg, subsequent encounter
S94.11XS Injury of medial plantar nerve, right leg, sequela
S94.12XA Injury of medial plantar nerve, left leg, initial encounter
S94.12XD Injury of medial plantar nerve, left leg, subsequent encounter
S94.12XS Injury of medial plantar nerve, left leg, sequela
S94.21XA Injury of deep peroneal nerve at ankle and foot level, right leg, initial encounter
S94.21XD Injury of deep peroneal nerve at ankle and foot level, right leg, subsequent encounter
S94.21XS Injury of deep peroneal nerve at ankle and foot level, right leg, sequela
S94.22XA Injury of deep peroneal nerve at ankle and foot level, left leg, initial encounter
S94.22XD Injury of deep peroneal nerve at ankle and foot level, left leg, subsequent encounter
S94.22XS Injury of deep peroneal nerve at ankle and foot level, left leg, sequela
S94.31XA Injury of cutaneous sensory nerve at ankle and foot level, right leg, initial encounter
S94.31XD Injury of cutaneous sensory nerve at ankle and foot level, right leg, subsequent encounter
S94.31XS Injury of cutaneous sensory nerve at ankle and foot level, right leg, sequela
S94.32XA Injury of cutaneous sensory nerve at ankle and foot level, left leg, initial encounter
S94.32XD Injury of cutaneous sensory nerve at ankle and foot level, left leg, subsequent encounter
S94.32XS Injury of cutaneous sensory nerve at ankle and foot level, left leg, sequela
S94.8X1A Injury of other nerves at ankle and foot level, right leg, initial encounter
S94.8X1D Injury of other nerves at ankle and foot level, right leg, subsequent encounter
S94.8X1S Injury of other nerves at ankle and foot level, right leg, sequela
S94.8X2A Injury of other nerves at ankle and foot level, left leg, initial encounter
S94.8X2D Injury of other nerves at ankle and foot level, left leg, subsequent encounter
S94.8X2S Injury of other nerves at ankle and foot level, left leg, sequela
S94.91XA Injury of unspecified nerve at ankle and foot level, right leg, initial encounter
S94.91XD Injury of unspecified nerve at ankle and foot level, right leg, subsequent encounter
S94.91XS Injury of unspecified nerve at ankle and foot level, right leg, sequela
S94.92XA Injury of unspecified nerve at ankle and foot level, left leg, initial encounter
S94.92XD Injury of unspecified nerve at ankle and foot level, left leg, subsequent encounter
S94.92XS 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
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*R07.9 is used to describe rib pain.

*G57.91, G57.92, G58.7, G58.8, G58.9, G59, M54.10 and M79.2 will be denied if 64450 is billed with CPT codes 76881, 76882, 76942, 76999, 97032, 97139, G0282 and/or G0283 on the same date of service (DOS). (Please see information in the ICD-10 Codes that DO NOT Support Medical Necessity section below).

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

Group 1

(25 Codes)
Group 1 Paragraph

All the ICD-10-CM codes listed below DO NOT support medical necessity and will deny when billing 64450 WITH 76881, 76882, 76942, 76999, 97032, 97139, G0282 and/or G0283 (above Group 2 CPT codes) for peripheral nerve blocks (including G57.91, G57.92, G58.7, G58.8, G58.9 G59, M54.10 and M79.2). Refer to the Coverage and Limitations section above.

All other ICD-10-CM codes not listed in this policy under "ICD-10 Codes that Support Medical Necessity" above.

Group 1 Codes
CodeDescription
G60.0 Hereditary motor and sensory neuropathy
G60.1 Refsum's disease
G60.2 Neuropathy in association with hereditary ataxia
G60.3 Idiopathic progressive neuropathy
G60.8 Other hereditary and idiopathic neuropathies
G60.9 Hereditary and idiopathic neuropathy, unspecified
G61.0 Guillain-Barre syndrome
G61.1 Serum neuropathy
G61.81 Chronic inflammatory demyelinating polyneuritis
G61.89 Other inflammatory polyneuropathies
G61.9 Inflammatory polyneuropathy, unspecified
G62.0 Drug-induced polyneuropathy
G62.2 Polyneuropathy due to other toxic agents
G62.81 Critical illness polyneuropathy
G62.82 Radiation-induced polyneuropathy
G62.89 Other specified polyneuropathies
G63 Polyneuropathy in diseases classified elsewhere
M25.571 Pain in right ankle and joints of right foot
M25.572 Pain in left ankle and joints of left foot
R20.0 Anesthesia of skin
R20.1 Hypoesthesia of skin
R20.2 Paresthesia of skin
R20.3 Hyperesthesia
R20.8 Other disturbances of skin sensation
R20.9 Unspecified disturbances of skin sensation

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.

CodeDescription
999x Not Applicable

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.

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 policy 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 policy should be assumed to apply equally to all Revenue Codes.


N/A

Other Coding Information

N/A

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
04/19/2022 N/A - N/A N/A You are here

Keywords

  • Nerve Blocks
  • Diabetic neuropathy
  • Peripheral Nerve
  • Chronic Pain
  • Neuropathy