How To Use CPT Code 64454

CPT 64454 is a code used for the injection of anesthetic agents and/or steroids into genicular nerve branches, including imaging guidance when performed. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64454 procedures.

1. What is CPT 64454?

CPT 64454 is a medical billing code used to describe the injection of anesthetic agents and/or steroids into the genicular nerve branches, which are nerves that supply the knee joint. This code also includes imaging guidance when performed. The procedure is typically used to diagnose or treat knee pain resulting from chronic osteoarthritis, degenerative joint disease, knee pain after partial or total knee replacement surgery, and knee pain in patients who are not candidates for or do not want a knee replacement.

2. 64454 CPT code description

The official description of CPT code 64454 is: “Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed.”

3. Procedure

1. The patient is appropriately prepped for the procedure.
2. A local anesthetic may be injected around the proposed injection site.
3. Using fluoroscopic guidance, the provider selects the area(s) for the injection(s).
4. A needle is inserted through the skin and into the deeper tissues.
5. Anesthetic agents and/or steroids are injected around the superolateral, superomedial, and/or inferomedial genicular nerve branches.
6. The needle is withdrawn.

4. Qualifying circumstances

Patients eligible to receive CPT 64454 services are those experiencing knee pain due to chronic osteoarthritis, degenerative joint disease, knee pain after partial or total knee replacement surgery, or knee pain in patients who are not candidates for or do not want a knee replacement. The procedure is performed to diagnose or treat the source of the knee pain and may be followed by radiofrequency ablation if the patient experiences a positive response, assessed by at least a 50 percent reduction in pain within 24 hours.

5. When to use CPT code 64454

It is appropriate to bill the 64454 CPT code when the provider performs the injection of anesthetic agents and/or steroids into the genicular nerve branches, including imaging guidance when performed, for the purpose of diagnosing or treating knee pain resulting from the aforementioned qualifying circumstances.

6. Documentation requirements

To support a claim for CPT 64454, the following information should be documented:

• Patient’s medical history and reason for the procedure
• Physical examination findings
• Diagnostic imaging results, if applicable
• Details of the procedure, including the specific genicular nerve branches targeted and the type and amount of anesthetic agents and/or steroids injected
• Any complications or adverse reactions during or after the procedure
• Post-procedure assessment and plan for follow-up care

7. Billing guidelines

When billing for CPT 64454, keep in mind the following guidelines and rules:

• If all three genicular nerve branches (superolateral, superomedial, and inferomedial) are not treated, add modifier 52 to the code.
• Do not report CPT 64454 in conjunction with CPT 64624.
• For bilateral procedures, report the appropriate code with modifier 50.

8. Historical information

CPT 64454 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates since its addition.

9. Similar codes to CPT 64454

Five similar codes to CPT 64454 and how they differentiate are:

1. CPT 64624: This code is used for the destruction of genicular nerve branches by neurolytic agent, including imaging guidance when performed.
2. CPT 64447: This code is used for the injection of an anesthetic agent to the femoral nerve.
3. CPT 64448: This code is used for the continuous infusion of an anesthetic agent to the femoral nerve.
4. CPT 64400-64489: These codes are used for the injection of anesthetic agents to diagnose or treat other areas of the body.
5. CPT 64455: This code is used for the injection of anesthetic agents and/or steroids into the plantar common digital nerve(s), including imaging guidance when performed.

10. Examples

Here are 10 detailed examples of CPT code 64454 procedures:

1. A 55-year-old patient with chronic osteoarthritis experiencing severe knee pain undergoes CPT 64454 to alleviate pain and improve mobility.
2. A 65-year-old patient with degenerative joint disease in the knee receives CPT 64454 to manage pain and avoid knee replacement surgery.
3. A 70-year-old patient who had a partial knee replacement surgery experiences persistent knee pain and undergoes CPT 64454 for pain relief.
4. A 60-year-old patient with knee pain due to osteoarthritis receives CPT 64454 as a diagnostic tool to determine the effectiveness of radiofrequency ablation as a more permanent therapy.
5. A 50-year-old patient with chronic knee pain not suitable for knee replacement surgery undergoes CPT 64454 to manage pain and improve quality of life.
6. A 45-year-old patient with knee pain after total knee replacement surgery receives CPT 64454 to alleviate pain and improve mobility.
7. A 75-year-old patient with degenerative joint disease in the knee undergoes CPT 64454 as a diagnostic tool to determine the source of pain and potential treatment options.
8. A 62-year-old patient with knee pain due to osteoarthritis receives CPT 64454 to manage pain and avoid knee replacement surgery.
9. A 58-year-old patient with chronic knee pain not suitable for knee replacement surgery undergoes CPT 64454 as a diagnostic tool to determine the effectiveness of radiofrequency ablation as a more permanent therapy.
10. A 67-year-old patient with knee pain after partial knee replacement surgery receives CPT 64454 to alleviate pain and improve mobility.