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With reimbursement based on value, collaborative care, and new technologies impacting anesthesiology, most practices rely on anesthesiology medical billing services for accurate claim submission. Each year brings about expectations of changes in codes and billing requirements in the anesthesia specialty.

Our last update looked at anesthesia coding and reporting guidelines for 2019. Let’s take a look at important changes that apply to anesthesia practices in 2020.

    • Amended intercostal nerve block codes: Intercostal codes are used for acute post-surgical pain relief. The changes to the CPT codes for intercostal nerve block codes (CPT 64400-64489) include deletions as well as revisions and additions.In 2019, either code 64420 (single) or 64421 (multiple) was used, not both. In 2020, blocking multiple levels will require coding both CPT 64420 (single) and CPT 64421 (additional level). These codes now read:64420: Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level

      +64421: intercostal nerve, each additional level (List separately in addition to code for primary procedure

      Key points to note:

      • The parent code for somatic nerve injections was revised by adding an (s) to clarify that multiple injections are included in the codes.
      • 64421 is now an add-on code.
      • One unit of 64421 can be coded for each additional intercostal nerve block done in excess of the initial level.
      • The RT and LT modifiers can be appended as 64421 is an add-on code.
      • Modifier 50 can be appended to the primary code, 64420, where applicable.
    • Nerve block code definition amended to permit steroid injections: The descriptors of nerve block codes 64400-64450 have also been changed to include steroid injections.
    • Clarifications on imaging guidance: CPT guidelines also distinguish between codes for which image guidance is included and those for which it can be separately reported.
      • Codes 64400-64450 do not include/bundle imaging guidance. So providers can bill imaging (such as ultrasound guidance) separately when performed and documented with this particular code set.
      • Imaging guidance is included in the codes for transforaminal epidural injections (CPT 64479-64484), paravertebral blocks (CPT codes 64461-64463) and TAP blocks (CPT 64486-64489).
      • Imaging guidance is also an inherent component of the new codes for 2020 to describe genicular and sacroiliac injections and destruction. CPT’s instructional guidance explains the number of units that can be billed for each code and if imaging guidance is included in the code descriptor (
    • Deleted nerve block codes: The following three nerve block codes were deleted in 2020 since they are rarely performed:64402 – Injection, anesthetic agent; facial nerve
      64410 – Injection, anesthetic agent; phrenic nerve
      64413 – Injection, anesthetic agent; cervical plexus

CPT instructs that the unlisted code 64499 should be reported if performed.

  • New genicular and sacroiliac codes: New genicular and sacroiliac codes (and instructions) became effective January 2020. Here are the 4 new codes and instructions for their use as listed by the American Academy of Pain Medicine:
    • 64451 Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e. fluoroscopy or computed tomography)

If performed using ultrasound guidance, the unlisted code 76999 should be reported. These services should not be reported in conjunction with codes that describe paravertebral facet joint injections (CPT 64493-64495), radiological guidance (CPT 77002, 77003, 77012) or guidance codes for chemodenervation (CPT 95873, 95874). Modifier 50 should be appended when performed bilaterally.

  • 64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with imaging guidance (i.e. fluoroscopy or computed tomography)

Do not report 64625 with destruction of lumbar or sacral facet joint (CPT 64635), radiological guidance (CPT 77002, 77003, 77012) or guidance codes for chemodenervation (CPT 95873, 95874). Code 64625 can be reported with modifier 50 when bilateral procedures are performed.

  • 64454 Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance when performed

This code requires injection of all nerve branches to include superolateral, superomedial, and inferomedial. If all three nerve branches are not injected, then modifier 52 (reduced services) should be appended to code 64454. Only one unit of service should be reported.

  • 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

Code 64624 requires destruction of three genicular nerve branches, includes imaging guidance, and should only be reported with one unit of service. Do not report this code in conjunction with the injection code (CPT 64451). Modifier 52 should be appended if all nerve branches are not destroyed.

The 2020 Medicare national conversion factor (CF) for anesthesia decreased while the 2020 CF for surgical services increased slightly. Several nerve block codes were revalued for 2020, reflecting an overall reduction in payment. It is important that anesthesiologists take note of these changes and avoid denials and/or payer scrutiny. An anesthesiology medical billing company with expert coders and billing specialists on board can help providers stay current with changes, submit accurate claims, and optimize reimbursement.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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