Billing and Coding: Peripheral Nerve Blocks

Social Security Act (Title XVIII) Standard References:

• Title XVIII of the Social Security Act, Section 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.

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33933, Peripheral Nerve Blocks. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Refer to the National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 2 and Chapter 8 for CPT codes 64400-64530 coding instructions.

Refer to LCD L33930 Facet Joint Interventions for Pain Management for information regarding billing paravertebral facet joint blocks on the same date of service.

Use of physical medicine and rehabilitation CPT/HCPCS codes (97032, 97139, G0282, G0283) for treatment of neuropathies or peripheral neuropathies caused by underlying systemic diseases is inappropriate. 

Documentation Requirements

1. All documentation must be maintained in the patient's medical record and made 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 documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
4. Assessment of the outcome of this procedure depends on the patient’s responses, therefore documentation should include:
   • Whether the block was a diagnostic or therapeutic injection 
   • Pre- and post-procedure evaluation of the patient
   • Patient education
5. When preemptive analgesia is performed by a provider other than the surgeon or the anesthesia professional who provides anesthesia/analgesia for the procedure, there must be a compelling patient care reason for the involvement of the additional provider. The rationale for this approach must be clearly documented in the medical record.