LCD Reference Article Billing and Coding Article

Billing and Coding: Nerve Blocks for Peripheral Neuropathy

A57589

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57589
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Nerve Blocks for Peripheral Neuropathy
Article Type
Billing and Coding
Original Effective Date
11/28/2019
Revision Effective Date
11/30/2023
Revision Ending Date
N/A
Retirement Date
N/A

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(1)(A) This section allowed coverage and payment for only those services that are considered to be medically reasonable and necessary.

Title XVIII of the Social Security Act, §1833(e) The section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, §1862 (a) (7). This section excludes routine physical examinations and services.

CMS Pub 100-03 Medicare National Coverage Determinations - Chapter 1 Sections:
30.3 – Acupuncture
150.6 -Vitamin B12 Injections to Strengthen Tendons, Ligaments, etc., of the Foot
150.7 - Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD.

Subcutaneous injections do not involve the structures described by CPT code 64450, direct injection into other peripheral nerves, but rather the injection of tissue surrounding a specific focus. These therapies are not to be coded using CPT code 64450. This code addresses the additional work of an injection of an anesthetic agent(s) (nerve block) and/or steroid by a qualified health care professional within their scope of practice.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician or non-physician practitioner responsible for and providing the care to the patient. 
  3. The submitted medical record should support the use of the selected diagnosis code(s). The submitted CPT/HCPCS code should describe the service performed.

Response To Comments

Number Comment Response
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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Group 1 Codes

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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(88 Codes)
Group 1 Paragraph

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Group 1 Codes
Code Description
A52.15 Late syphilitic neuropathy
E08.40 - E08.43 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified - Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy
E09.40 - E09.43 Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified - Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy
E10.40 - E10.43 Type 1 diabetes mellitus with diabetic neuropathy, unspecified - Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.40 - E11.43 Type 2 diabetes mellitus with diabetic neuropathy, unspecified - Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.40 - E13.43 Other specified diabetes mellitus with diabetic neuropathy, unspecified - Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
G13.0 Paraneoplastic neuromyopathy and neuropathy
G58.9 - G65.2 Mononeuropathy, unspecified - Sequelae of toxic polyneuropathy
M05.50 - M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site - Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M34.83 Systemic sclerosis with polyneuropathy
M79.2 Neuralgia and neuritis, unspecified
M79.603 Pain in arm, unspecified
M79.606 Pain in leg, unspecified
M79.609 Pain in unspecified limb
M79.629 Pain in unspecified upper arm
M79.639 Pain in unspecified forearm
M79.643 Pain in unspecified hand
M79.646 Pain in unspecified finger(s)
M79.659 Pain in unspecified thigh
M79.669 Pain in unspecified lower leg
M79.673 Pain in unspecified foot
M79.676 Pain in unspecified toe(s)
R20.0 Anesthesia of skin
R20.1 Hypoesthesia of skin
R20.8 Other disturbances of skin sensation
R20.9 Unspecified disturbances of skin sensation
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ICD-10-PCS Codes

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
11/30/2023 R5

Posted 11/30/2023- Under CMS National Coverage Policy updated section heading for regulations.

01/01/2023 R4

Posted 01/26/2023 Under CPT/HCPCS Codes Group 2 Codes CPT code 76882 had a description change. This revision is due to the Annual 2023/Q1 CPT/HCPCS Code Update and is effective 01/01/2023.

11/25/2021 R3

11/25/2021 Review completed 10/26/2021. Updated CMS National Coverage Policy section. Removed Title XVIII of the Social Security Act, section 1862(a)(1)(A). This section allows coverage and payment for only those services that are considered to be medically reasonable and necessary. Added Title XVIII of the Social Security Act, §1862(a)(1)(A) statutory exclusion covers diagnostic testing "except for items and services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member". Removed Title XVIII of the Social Security Act, section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Added Title XVIII of the Social Security Act, §1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period. Removed Title XVIII of the Social Security Act, section 1862 (a)(7) excludes routine physical evaluations. Added Title XVIII of the Social Security Act, §1862 (a) (7). This section excludes routine physical examinations and services.

09/13/2020 R2

07/30/2020 To Article Guidance added the following, “and/or steroid by a qualified health care professional within their scope of practice and deleted the following “into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively easily localized area”
Added codes to ICD-10 Codes that DO NOT Support Medical Necessity effective 09/13/2020. Utilization Guidelines removed due to redundancy since located in LCD L35222 Nerve Blocks for Peripheral Neuropathy.

01/01/2020 R1

CPT/HCPCS annual update effective 01/01/2020: CPT/HCPCS Codes Group 1 Codes: description change noted to 64450. Format revisions completed.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L35222 - Nerve Blocks for Peripheral Neuropathy
SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
11/20/2023 11/30/2023 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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