Be Prepared for New and Revised CPT Codes for Somatic Nerve Injections and Destruction
CPT 2020 makes significant changes to the family of codes for Somatic Nerve Injections (CPT 64400-64489). This includes code additions, deletions and revisions to existing codes and the introductory guidelines. New codes are also added to report destruction of the genicular nerves and radiofrequency ablation of the sacroiliac joint.
The guidelines clarify that nerve injection codes are to be reported once per nerve plexus, nerve, or branch regardless of the number of injections performed. CPT also clarifies codes for which image guidance is included vs. those for which it can be separately reported. Imaging guidance can be reported separately for codes 64400-64450 when performed and documented. Imaging guidance is an inherent component in the codes for transforaminal epidural injections (CPT 64479-64484), paravertebral blocks (CPT codes 64461-64463) and TAP blocks (CPT 64486-64489). Imaging guidance is also included in the new codes for 2020 to describe genicular and sacroiliac injections and destruction. An instructional table is added to CPT that explains the number of units that can be billed for each code and if imaging guidance is included in the code descriptor.
The parent code for somatic nerve injections is revised by adding an (s) to clarify that multiple injections are included in the codes. It reads: Injection(s), anesthetic agent(s) and/or steroid. Codes 64402, 64410 and 64413 (injection of facial, phrenic, and cervical plexus) are deleted since they are rarely performed. If performed, CPT indicates that the unlisted code 64499 should be reported.
The existing code for injection of the intercostal nerve (CPT 64421) has been changed to an add-on code to report each additional level of intercostal nerve injections and is billed in conjunction with 64420. These codes now read:
64420: Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level
+64421: intercostal nerve, each additional level (List separately in addition to code for primary procedure
A new code (CPT 64451) has been added to describe injection(s) into nerves innervating the sacroiliac joint (SI) and includes fluoroscopy or CT guidance. If performed using ultrasound guidance, the unlisted code 76999 should be reported. There are also exclusionary notes instructing users not to report these services in conjunction with codes that describe paravertebral facet joint injections (CPT 64493-64495), radiological guidance (CPT 77002, 77003, 77012) or guidance codes for chemodenervation (CPT 95873, 95874). Since this service can be performed bilaterally, the instructions indicate that modifier 50 should be appended when performed bilaterally.
There is a corresponding new code (CPT 64625) to describe radiofrequency ablation of the SI nerves and includes imaging guidance. Parenthetical instructions prohibit it from being reported with destruction of lumbar or sacral facet joint (CPT 64635), radiological guidance (CPT 77002, 77003, 77012) or guidance codes for chemodenervation (CPT 95873, 95874). It can be reported with modifier 50 when bilateral procedures are performed.
There is also a new code (CPT 64454) for injection of the genicular nerves. The parenthetical notes state the code requires injection of all nerve branches to include superolateral, superomedial, and inferomedial. If all three nerve branches are not injected, then modifier 52 (reduced services) should be appended to code 64454. Only one unit of service should be reported. The notes also clarify that the codes should not be reported in conjunction with the new code 64624 that describes destruction of these nerves.
Code 64624 is added to describe destruction of the genicular nerve branches. Like the injection code, it requires destruction of three nerve branches, includes imaging guidance and should only be reported with one unit of service. It should not be reported in conjunction with the injection code (CPT 64451) and modifier 52 should be appended if all nerve branches are not destroyed.
Below are the descriptors for new genicular and sacroiliac codes. The CPT book should be consulted for all the parenthetical and introductory guidelines.
Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e. fluoroscopy or computed tomography)
Radiofrequency ablation, nerves innervating the sacroiliac joint, with imaging guidance (i.e. fluoroscopy or computed tomography)
Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance when performed
Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed
The new codes are effective January 1, 2020. CPT instructs that the code most specific for the service provided should be used. Therefore, it would not be appropriate to report any other CPT codes to describe the above procedures including codes used in prior years. It is important to make sure that all physicians, other providers and staff are aware of the new changes to avoid denials and/or payer reviews.