How To Use CPT Code 64420

CPT 64420 describes the injection of an anesthetic agent and/or steroid into the intercostal nerve, which is a branch of the thoracic spinal nerves located under each rib. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64420?

CPT 64420 can be used to describe the injection of an anesthetic agent and/or steroid into the intercostal nerve, which is one of the twelve bilateral nerves that arise from the thoracic spinal nerves. This code is used when the provider administers one or more injections at a single level during a single procedure to anesthetize the area supplied by the intercostal nerve.

2. Official Description

The official description of CPT code 64420 is: ‘Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level.’

3. Procedure

1. The provider prepares the patient for the procedure.
2. Using a needle and syringe, the provider administers one or more injections of an anesthetic agent and/or steroid close to the intercostal nerve.
3. This procedure is performed at a single level to treat acute and chronic pain conditions in the chest area, relieve the pain of rib fractures, or as a local anesthetic for thoracic, upper abdominal, or breast surgery.
4. It may also be performed for diagnostic purposes.

4. Qualifying circumstances

CPT 64420 is used for patients who require an injection of an anesthetic agent and/or steroid into the intercostal nerve to treat acute or chronic pain conditions in the chest area, relieve rib fracture pain, or provide local anesthesia for certain surgeries. The procedure is performed by a qualified provider and is done at a single level.

5. When to use CPT code 64420

CPT code 64420 should be used when the provider administers an injection of an anesthetic agent and/or steroid into the intercostal nerve at a single level during a single procedure. It is important to note that this code is reported based on the number of levels injected, not the number of injections.

6. Documentation requirements

To support a claim for CPT 64420, the provider must document the following information:

• Reason for the injection and the specific pain condition being treated
• Number of injections administered
• Level at which the injection was performed
• Any additional procedures performed during the same session
• Signature of the provider

7. Billing guidelines

When billing for CPT 64420, ensure that the injection is performed by a qualified provider and is done at a single level. This code should not be reported with other codes for bilateral procedures. If additional levels of the intercostal nerve are injected, report CPT code 64421 in addition to 64420 as the primary code.

8. Historical information

CPT 64420 was added to the Current Procedural Terminology system on January 1, 1990. The code was last updated on January 1, 2020, with a change in the description.

9. Examples

1. A patient with chronic chest pain receives an injection of an anesthetic agent and steroid into the intercostal nerve to alleviate their symptoms.
2. Following a rib fracture, a patient undergoes an intercostal nerve block to manage their pain during the healing process.
3. During thoracic surgery, a patient receives a local anesthetic injection into the intercostal nerve to ensure pain control during the procedure.
4. A diagnostic intercostal nerve block is performed on a patient with undiagnosed chest pain to determine the source of their discomfort.
5. A patient undergoing breast surgery receives an injection of an anesthetic agent and steroid into the intercostal nerve to provide local anesthesia and pain relief.
6. A provider administers an intercostal nerve block to a patient with chronic intercostal neuralgia to manage their ongoing pain.
7. Following abdominal surgery, a patient receives an injection into the intercostal nerve to provide localized pain relief.
8. A patient with post-herpetic neuralgia receives an intercostal nerve block to alleviate their persistent pain.
9. During a diagnostic workup for chest pain, a patient undergoes an intercostal nerve block to determine if the pain is originating from the intercostal nerves.
10. A patient with chronic rib pain receives an injection into the intercostal nerve to manage their ongoing discomfort.