While working with various internists, we observed lot of doubt about current procedure (CPT) code 64625. Inaccurate use of CPT code 64625 could lead to claim denials and hence lost revenue. In this article, we tried to resolve common queries and doubts while billing 64625. Let’s begin with understanding basics of the code.
Basics of CPT Code 64625
CPT code 64625 refers to a nerve block injection of the occipital nerves. This procedure is used to relieve pain in the head and neck areas. The occipital nerves are located at the back of the head and can become inflamed or irritated, causing pain. A nerve block injection involves injecting medication directly into the nerves to reduce inflammation and relieve pain. The injection is typically performed in an outpatient setting, such as a doctor’s office or a hospital. The patient will be positioned face down on a table, and the injection site will be cleaned and numbed with a local anesthetic. The doctor will then use a small needle to inject a combination of anesthetic and steroid medication into the occipital nerves. The CPT code 64625 includes the following components:
- Pre-operative evaluation and management of the patient
- Use of imaging guidance (if necessary) to locate the injection site
- Injection of local anesthesia and steroid medication into the occipital nerves
- Post-operative evaluation and management of the patient
It is important to note that the use of imaging guidance is not always necessary for this procedure. The decision to use imaging guidance will depend on the individual patient’s anatomy and the doctor’s preference.
Resolving Commons Doubts while Billing 64625
1. 64625 CPT Code Reimbursement
The reimbursement amount for CPT code 64625 varies depending on a variety of factors, including the location where the procedure is performed, the provider performing the procedure, and the patient’s insurance coverage. It is best to contact the patient’s insurance company to get accurate information on billing 64625. The insurance company will be able to provide exact code reimbursement, potential out-of-pocket costs for the patient, and billing guidelines.
2. Is CPT 64625 Covered by Medicare?
CPT code 64625 is covered by Medicare. However, it is important to note that Medicare coverage and reimbursement rates may vary depending on the specific circumstances of the procedure, such as the location where the procedure is performed and the patient’s individual coverage plan. To determine the specific Medicare coverage and reimbursement amount for CPT code 64625, it is best to contact Medicare directly.
3. 64625 vs. 64635
CPT code 64635 refers to a trigeminal nerve block injection, which is used to treat trigeminal neuralgia, a type of facial pain that is caused by inflammation or compression of the trigeminal nerve. This injection involves the injection of local anesthetic and/or steroid medication into the trigeminal nerve branches to relieve pain. While both CPT codes involve nerve block injections for pain relief, they are used to treat different conditions and involve injections into different nerves.
4. Can You Bill 64625 and 64635 together?
It is possible to bill CPT code 64625 and CPT code 64635 together if both nerve block injections were performed during the same patient encounter and if both procedures were medically necessary for the treatment of the patient’s condition. However, it is important to note that the use of multiple CPT codes for the same patient encounter may be subject to certain billing and coding guidelines and regulations, which may vary depending on the payer or insurance plan.
In some cases, the use of multiple codes may require additional documentation and justification to support medical necessity and avoid billing errors or denials. To ensure proper billing and coding practices, providers and medical billers should be familiar with the specific requirements and guidelines for billing these codes, which may include documentation of the patient’s diagnosis, the specific nerves injected, and the medications used during the injection. You may also consult with the payer or insurance plan for guidance on proper coding and billing practices for billing 64625.
5. Is CPT Code 64625 Experimental?
CPT code 64625 is not considered an experimental or investigational procedure. It is a well-established procedure that is recognized and accepted by the medical community for the treatment of occipital neuralgia. As discussed earlier, the coverage and reimbursement rates for CPT code 64625 may vary depending on the payer or insurance plan, it is generally recognized as a standard procedure for the treatment of occipital neuralgia and is not considered experimental or investigational.
6. What CPT Code did 64625 Replace?
CPT code 64625 did not replace any specific previous code. It is a unique code that was introduced by the American Medical Association (AMA) in 2005. Prior to the introduction of CPT code 64625, healthcare providers may have used other codes to describe similar procedures, such as codes for trigger point injections or nerve block injections. However, CPT code 64625 was specifically developed to describe the injection of medication into the occipital nerves for the treatment of occipital neuralgia, and it is now the preferred code for this procedure.
We hope that this article might have cleared few doubts and provided all necessary information while billing 64625. Medisys Data Solutions is a leading medical billing company providing complete billing and coding services for various medical billing specialties including internal medicine. Our billing and coding experts are well aware of billing guidelines to receive accurate reimbursement for delivered services. To know more about our internal medicine billing services, contact us at info@medisysdata.com / 888-720-8884
