How To Use CPT Code 64400

CPT 64400 is a code used for injections of anesthetic agents and/or steroids into the trigeminal nerve branches. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64400.

1. What is CPT 64400?

CPT 64400 is a medical code used to describe the procedure of injecting anesthetic agents and/or steroids into the branches of the trigeminal nerve. This procedure is performed to treat conditions such as trigeminal neuralgia or postherpetic neuralgia, as well as for diagnostic purposes. The code can be reported for each branch of the trigeminal nerve injected during a single procedure.

2. 64400 CPT code description

The official description of CPT code 64400 is: “Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular)”

3. Procedure

The 64400 procedure involves the following steps:

1. The patient is appropriately prepped for the procedure.
2. The provider uses a needle and syringe to administer one or more injections of an anesthetic agent and/or steroid close to a trigeminal nerve branch.
3. The area supplied by the nerve is anesthetized.
4. The provider may perform additional diagnostic or therapeutic procedures as needed.
5. The patient is monitored for any adverse reactions or complications.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 64400 services are those who suffer from conditions such as trigeminal neuralgia, a nerve disease that causes intense facial pain, or postherpetic neuralgia, a complication of shingles of the face that causes burning facial pain. Additionally, patients who require diagnostic procedures involving the trigeminal nerve may also qualify for this service.

5. When to use CPT code 64400

It is appropriate to bill the 64400 CPT code when the provider performs an injection of anesthetic agents and/or steroids into one or more branches of the trigeminal nerve for the purpose of treating conditions such as trigeminal neuralgia or postherpetic neuralgia, or for diagnostic purposes. The code should be reported for each branch of the trigeminal nerve injected during a single procedure.

6. Documentation requirements

Documentation supporting a claim for CPT 64400 should include the following information:

• Patient’s medical history and relevant diagnoses
• Indication for the procedure
• Details of the procedure, including the specific branch(es) of the trigeminal nerve injected
• Type and dosage of anesthetic agent(s) and/or steroid(s) used
• Any additional diagnostic or therapeutic procedures performed
• Outcome of the procedure and any complications or adverse reactions

7. Billing guidelines

When billing for CPT code 64400, it is important to follow the appropriate guidelines and rules. The code should be reported for each branch of the trigeminal nerve injected during a single procedure. However, if a single branch is injected more than once, the code may be reported only once. For bilateral procedures, report CPT 64400 with modifier 50.

8. Historical information

CPT 64400 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2020, with the previous descriptor being “Injection, anesthetic agent; trigeminal nerve, any division or branch.”

9. Similar codes to CPT 64400

Five similar codes to CPT 64400 and how they differentiate are:

• CPT 64405: Involves injection into the occipital nerve, rather than the trigeminal nerve branches.
• CPT 64408: Focuses on the injection into the facial nerve, not the trigeminal nerve branches.
• CPT 64415: Pertains to the injection into the brachial plexus, which is a different nerve structure than the trigeminal nerve.
• CPT 64416: Involves injection into the suprascapular nerve, not the trigeminal nerve branches.
• CPT 64417: Refers to the injection into the axillary nerve, which is distinct from the trigeminal nerve branches.

10. Examples

Here are 10 detailed examples of CPT code 64400 procedures:

1. A patient with trigeminal neuralgia receives an injection into the ophthalmic branch of the trigeminal nerve.
2. A patient with postherpetic neuralgia undergoes an injection into the maxillary branch of the trigeminal nerve.
3. A patient with facial pain receives injections into both the ophthalmic and maxillary branches of the trigeminal nerve during a single procedure.
4. A patient with suspected trigeminal nerve involvement undergoes diagnostic injections into all three branches of the trigeminal nerve.
5. A patient with atypical facial pain receives an injection into the mandibular branch of the trigeminal nerve for diagnostic purposes.
6. A patient with trigeminal neuralgia undergoes a bilateral injection into the ophthalmic branches of the trigeminal nerve, reported with modifier 50.
7. A patient with postherpetic neuralgia receives a series of injections into the maxillary branch of the trigeminal nerve over several weeks, with each injection reported separately.
8. A patient with facial pain undergoes an injection into the ophthalmic branch of the trigeminal nerve, followed by additional diagnostic procedures.
9. A patient with trigeminal neuralgia receives an injection into the mandibular branch of the trigeminal nerve, followed by a therapeutic procedure.
10. A patient with facial pain undergoes an injection into the maxillary branch of the trigeminal nerve, with subsequent monitoring for adverse reactions or complications.