How To Use CPT Code 64405

CPT 64405 refers to the injection of anesthetic agent(s) and/or steroid into the greater occipital nerve, primarily used for relieving occipital neuralgia or cervicogenic headaches. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 64405.

1. What is CPT 64405?

CPT 64405 is a medical procedure code that describes the injection of anesthetic agent(s) and/or steroid into the greater occipital nerve. This procedure is primarily used to relieve occipital neuralgia or cervicogenic headaches, which are caused by trauma to the nerves at the back of the head or problems in the cervical spine. It may also be performed for diagnostic purposes.

2. 64405 CPT code description

The official description of CPT code 64405 is: “Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve.”

3. Procedure

The 64405 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 anesthetic agent and/or steroid close to the greater occipital nerve.
3. The injected substances anesthetize the area supplied by the nerve, providing relief from pain.
4. The provider may perform additional diagnostic tests or assessments as needed.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 64405 services include those experiencing:

• Occipital neuralgia, an intense nerve-related headache pain often due to trauma to the nerves at the back of the head.
• Cervicogenic headaches, which occur due to a problem in the cervical spine, the part of the neck near the base of the skull.
• Other conditions where the provider deems it necessary to perform an occipital nerve block for diagnostic or therapeutic purposes.

5. When to use CPT code 64405

It is appropriate to bill the 64405 CPT code when the provider performs an injection of anesthetic agent(s) and/or steroid into the greater occipital nerve to relieve occipital neuralgia, cervicogenic headaches, or for diagnostic purposes. The provider must determine that the procedure is medically necessary and document the patient’s symptoms, diagnosis, and treatment plan.

6. Documentation requirements

To support a claim for CPT 64405, the following information should be documented:

• Patient’s medical history and symptoms related to occipital neuralgia or cervicogenic headaches.
• Physical examination findings, including any tenderness or pain in the occipital region.
• Diagnosis and treatment plan, including the rationale for performing the occipital nerve block.
• Details of the procedure, including the type and amount of anesthetic agent(s) and/or steroid used, the number of injections, and the patient’s response to the treatment.
• Any follow-up care or additional treatments required.

7. Billing guidelines

When billing for CPT code 64405, it is important to follow the appropriate guidelines and rules. These may include:

• Using modifier 50 for bilateral procedures.
• Ensuring that the procedure is medically necessary and supported by documentation.
• Verifying payer-specific requirements and policies related to CPT 64405.

8. Historical information

CPT 64405 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; greater occipital nerve.”

9. Similar codes to CPT 64405

Five similar codes to CPT 64405 include:

• CPT 64400: Injection of anesthetic agent(s) and/or steroid into the trigeminal nerve.
• CPT 64408: Injection of anesthetic agent(s) and/or steroid into the facial nerve.
• CPT 64415: Injection of anesthetic agent(s) and/or steroid into the brachial plexus.
• CPT 64418: Injection of anesthetic agent(s) and/or steroid into the suprascapular nerve.
• CPT 64450: Injection of anesthetic agent(s) and/or steroid into other peripheral nerve or branch.

10. Examples

Here are 10 detailed examples of CPT code 64405 procedures:

1. A patient with a history of occipital neuralgia receives a greater occipital nerve block using a combination of anesthetic agent and steroid to alleviate pain.
2. A patient with cervicogenic headaches undergoes a diagnostic occipital nerve block to determine the source of their pain.
3. A patient with chronic headaches receives a greater occipital nerve block as part of a comprehensive treatment plan.
4. A patient with a history of trauma to the back of the head undergoes a greater occipital nerve block to relieve persistent pain.
5. A patient with a suspected cervical spine issue receives a greater occipital nerve block to help diagnose the cause of their headaches.
6. A patient with occipital neuralgia undergoes a bilateral greater occipital nerve block using modifier 50 to indicate the bilateral procedure.
7. A patient with a history of failed conservative treatments for cervicogenic headaches receives a greater occipital nerve block as a therapeutic intervention.
8. A patient with chronic occipital neuralgia undergoes a series of greater occipital nerve blocks as part of a long-term pain management plan.
9. A patient with a suspected nerve compression in the cervical spine receives a greater occipital nerve block to help determine the cause of their pain.
10. A patient with a history of occipital neuralgia and cervicogenic headaches undergoes a greater occipital nerve block to provide relief from both conditions.