New Pain Management Codes: Genicular Nerves and SI Joint Nerves
Published on January 15, 2020
This year’s publication of CPT contains 4 new procedure codes for pain management. They are for procedures which have been performed without the benefit of specific codes for some time now. Two of the codes are for procedures on the genicular nerve branches, a nerve block and a nerve destruction. The other two codes are for procedures on the nerves innervating the sacroiliac joint, again, a nerve block and a nerve destruction code.
Genicular Nerve and Branches
The nerve block for the genicular nerve branches (64454) includes imaging guidance as many interventional pain procedures do, so ultrasound guidance is not separately reportable. Also, it is important to document all of the genicular nerve branches that are blocked. The code includes all of the following branches: superolateral, superomedial, and inferomedial. CPT directs coders that if all 3 of these genicular nerve branches are not injected, a 52 modifier (reduced services) is required. Additionally, the genicular nerve block, should not be billed with in conjunction with genicular nerve destruction. It is only reported once per session regardless of the number of branches injected. The genicular nerve destruction (64624) likewise requires that all three of the above-mentioned branches be treated, so it is again, important to document each nerve branch treated. As with the nerve block, a 52 modifier must be appended if all three branches are not treated. Also, just like the nerve block, the destruction includes imaging guidance. Again, it is reported only once per session.
Nerves Innervating the Sacroiliac Joint
The new code for SI joint nerve block (64451), like the code for the SI joint injection, states that the procedure is performed under either computed tomography or fluoroscopy, indicating that the fluoroscopy is not separately billable. Because the descriptor includes fluoroscopy or CT, is important to document any imaging guidance that is used clearly and fully. The destruction code (64625) also includes CT or fluoroscopy in its descriptor. As with the other new codes, the SI joint nerve block and destruction codes are mutually exclusive, meaning they cannot be reported together. Each code should only be reported once per session and includes all nerves innervating the SI joint.
Thorough documentation of the procedure and any guidance used will be the key in obtaining proper reimbursement for these new codes.
Current Procedural Terminology (CPT). American Medical Association, 2020.
By Heather E. Golfos, CPC, CANPC
Coding Department Manager