How To Use CPT Code 64450

CPT 64450 refers to the injection of anesthetic agents and/or steroids into peripheral nerves or branches for pain relief or diagnostic purposes. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64450.

1. What is CPT 64450?

CPT 64450 is a medical billing code used to describe the injection of anesthetic agents and/or steroids into peripheral nerves or branches. This procedure is performed to relieve pain, desensitize an area for surgery, or for diagnostic purposes. The code represents a unilateral service, meaning it is performed on one side of the body. If the procedure is performed bilaterally, specific modifiers must be used.

2. 64450 CPT code description

The official description of CPT code 64450 is: “Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch.”

3. Procedure

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, steroid, or both close to a peripheral nerve or branch.
3. The area supplied by the nerve is anesthetized.
4. The provider withdraws the needle and applies a bandage to the injection site.

4. Qualifying circumstances

Patients eligible to receive CPT code 64450 services are those experiencing pain or requiring desensitization of an area for surgery or diagnostic purposes. The provider must determine that the injection of anesthetic agents and/or steroids into peripheral nerves or branches is the most appropriate course of action for the patient’s condition.

5. When to use CPT code 64450

It is appropriate to bill CPT code 64450 when the provider performs the procedure as described above for pain relief, desensitization of an area for surgery, or diagnostic purposes. The code should only be used for unilateral procedures, with specific modifiers applied for bilateral procedures.

6. Documentation requirements

To support a claim for CPT 64450, the following information should be documented:

• Patient’s medical history and reason for the procedure
• Physical examination findings
• Diagnosis and treatment plan
• Details of the procedure, including the specific nerve or branch targeted, the type and amount of anesthetic agent and/or steroid used, and the number of injections administered
• Post-procedure assessment and follow-up plan

7. Billing guidelines

When billing for CPT code 64450, it is important to follow payer-specific guidelines and rules. For unilateral procedures, report the code once. For bilateral procedures, report the code once with modifier 50, or report it twice, once with modifier RT and again with modifier LT, depending on each payer’s preference. Additionally, be aware of similar codes and their appropriate usage to ensure accurate billing.

8. Historical information

CPT 64450 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; other peripheral nerve or branch.”

9. Similar codes to CPT 64450

Five similar codes to CPT 64450 and how they differentiate are:

1. CPT 64451: Involves the injection of anesthetic agents into nerves innervating the sacroiliac joint.
2. CPT 64455: Used for the injection of anesthetic agents or steroids into the plantar common digital nerve, such as in Morton’s neuroma.
3. CPT 64461: Describes the injection of anesthetic agents into the paravertebral facet joint.
4. CPT 64479: Involves the injection of anesthetic agents into the lumbar or sacral spine.
5. CPT 64483: Refers to the injection of anesthetic agents into the lumbar or sacral spine with imaging guidance.

10. Examples

1. A patient with chronic pain in the wrist due to carpal tunnel syndrome receives an injection of an anesthetic agent into the median nerve.
2. A patient with Morton’s neuroma undergoes an injection of a steroid into the plantar common digital nerve for pain relief.
3. A patient with sciatica receives an injection of an anesthetic agent into the sciatic nerve for diagnostic purposes.
4. A patient with occipital neuralgia undergoes an injection of a steroid into the occipital nerve for pain relief.
5. A patient with postherpetic neuralgia receives an injection of an anesthetic agent into the intercostal nerve for pain relief.
6. A patient with trigeminal neuralgia undergoes an injection of a steroid into the trigeminal nerve for pain relief.
7. A patient with ilioinguinal neuralgia receives an injection of an anesthetic agent into the ilioinguinal nerve for diagnostic purposes.
8. A patient with meralgia paresthetica undergoes an injection of a steroid into the lateral femoral cutaneous nerve for pain relief.
9. A patient with tarsal tunnel syndrome receives an injection of an anesthetic agent into the posterior tibial nerve for diagnostic purposes.
10. A patient with suprascapular nerve entrapment undergoes an injection of a steroid into the suprascapular nerve for pain relief.