CPT-4 coding challenge: Coding nerve blocks 64400-64455

March 30, 2022 / By Jean Stoner

One of the more challenging decisions a coder must make is whether to code nerve blocks for surgical procedures. We often find clear documentation of the nerve block(s), and there are certainly CPT-4 codes for many different kinds of nerve blocks, but should they always be coded? Let’s test your knowledge with a common procedure: trigger finger release.

What CPT-4 code(s) should be assigned for this procedure?

PREOPERATIVE DIAGNOSES:
1. Left ring finger trigger.
2. Left finger pain.

PROCEDURES PERFORMED:
1. Left ring finger pulley release.
2. Peripheral nerve block for pain.

DESCRIPTION OF PROCEDURE: The patient was identified in preoperative holding area. Surgical site marked. Brought to the OR table, positioned supine. Tourniquet applied on proximal arm. A peripheral nerve block given consisting of 5 cc of 1% lidocaine with epinephrine and 0.25% Marcaine plain as a digital block for pain control and vasoconstriction. He was prepped and draped in usual sterile fashion. A time-out performed.

Preoperative antibiotics given. Extremity exsanguinated using Esmarch bandage. Tourniquet inflated to 220 mmHg. Transverse incision made in line with ring finger. Incision taken through subcutaneous tissues and palmar fascia. The digital bundles on both sides were identified and protected throughout the case. A1 pulley released under direct vision. Inflamed flexor tenosynovium excised sharply with scissors. The finger was taken through range of motion and found not to trigger. Hemostasis was obtained. Wound was washed out. Incision was closed with 4 – 0 nylon. Sterile dressing applied.

Get the answer here.

Jean Stoner, CPC, product owner for computer-assisted coding (CAC) content for outpatient and professional services for 3M Health Information Systems.

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