This page addresses follow-up questions and additional information pertinent to our webinar
Getting Through the Op Report Without Crying: Case Studies in Nerve Procedures.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q: Can peripheral nerve blocks be reported on the same day of surgery?
A: Yes, they can if they are performed for post-operative pain management and if the operative anesthesia is general anesthesia, subarachnoid injection or epidural injection In addition, the adequacy of the intraoperative anesthesia cannot be dependent on the peripheral nerve block. They are not separately reportable if the surgeon performing the surgery also performs the block such as a bier block for ganglion removal.

Q: I keep getting denials from Medicare when I bill for dry needling, do you have any ideas?
A: I would need to see the documentation and codes used, however there is a Medicare Article (A57452) that does state that dry needling ganglion cysts, ligaments, neuromas, peripheral nerves, tendon sheaths and their origins/insertions, or any tissue are non-covered procedures.

Q: My provider is performing Intercostobrachial nerve blocks, is this reported with 64415 (brachial plexus), 64420 (intercostal) or 64450 (other peripheral nerve)?
A: The intercostobrachial nerve arises from the second thoracic (T2 and occasionally T1) nerve root. As such, it is not a component of the brachial plexus and is, therefore, not anesthetized by any brachial plexus approach. Since the intercostobrachial nerve provides innervation to the skin of the axilla and proximal arm, CPT 64450 for the peripheral nerve would be the appropriate code to report this with.

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