Episode Summaries

BlockHeads aims to build a strong community of emergency medicine experts who share best practices and helpful tips for adopting ultrasound-guided regional analgesia in the emergency setting. To that end, we will regularly share summaries from our monthly Zoom meetings to highlight key points.

If you find these topics interesting and would like to get involved, we would love to have you join us at our next meeting!

Episode Topic: Billing and Coding

This newsletter provides a concise overview of Dr Vlasica’s discussion of billing and coding considerations for nerve blocks performed in the ER setting.

  • CPT Codes:

  • Specific CPT codes exist for most nerve blocks (e.g., brachial plexus block). Many of these codes now include ultrasound guidance.

  • Use separate CPT codes for blocks with dedicated codes.

  • For blocks without specific codes, use a generic code (e.g., 64450) but expect lower reimbursement.

  • Ultrasound Guidance:

  • Since 2023, ultrasound guidance is included in most nerve block CPT codes. You cannot bill a separate code for it.

  • Facility vs. Professional Fee:

  • You cannot bill a facility fee if you use your own handheld ultrasound machine.

  • You can bill a professional fee for performing the block using ultrasound for guidance.

  • Telephone Follow-Up:

  • Reimbursement depends on the payer's policy (e.g., Medicare does not cover it).

  • Document the call in the patient's record using an E/M code (9441-9443) even if not reimbursed.

  • 2023 E/M Coding Changes:

  • Bill for POCUS exams (point-of-care ultrasound) using separate CPT codes for better reimbursement compared to including them in E/M coding.

  • Challenges and Best Practices:

  • Track your billing and reimbursement to identify areas for improvement.

  • Improper claim submission can lead to low reimbursement for POCUS exams.

  • Work with your revenue cycle department to optimize POCUS billing.

  • Avoid including proposed CPT codes in your documentation as it may not reflect the actual service.

  • CPT Codes

    • 20552 Trigger point 1-2 

    • 20553 Trigger point 2-3

    • 64400 Trigeminal nerve branches 

    • 64405 Greater occipital nerve

    • 64450 Lesser occipital nerve/ OTHER 

    • 64505 Sphenopalatine ganglion block 

    • 64413 Superficial cervical plexus 

    • 64415 Brachial plexus

    • 64417 Axillary 

    • 64421 Injection intercostal nerves multiple regional block, Erector spinae 

    • 64447 Femoral nerve

    • 64445 sciatic nerve

    • 64461 paravertebral paraspinal block

    • 64486 transversus abdominis plane 

    • 64488 rectus sheath block

    • 64999 Unlisted procedure, nervous system

By understanding these key points, ER doctors can ensure proper billing and coding for nerve blocks, maximizing their practice's revenue while delivering high-quality patient care.