When you have a procedure that can cover two close but distinctly different areas such as a facial and a dental nerve block, you need to make sure that your claim encompasses exactly the procedure that was done or you may wind up with a denial of your claim.
A common situation would be if the ED physician performed a diagnostic nerve block on a patient complaining of pain in the floor of her mouth and her bottom set of teeth. You would want to be certain that you chose 64402 (Injection, anesthetic agent; facial nerve) for facial nerve blocks, not blocks in the mouth or jaw. The determining factor is that the surgeon treated a branch of the trigeminal nerve, not the facial nerve.
On the claim, report 64400 (… trigeminal nerve, any division or branch) for the nerve block. Other 64400 scenarios: Areas affected by the trigeminal nerve and its branches, and therefore coded with 64400 for nerve blocks, include:
- the body of the mandible and the lower portion of the ramus
- upper and lower teeth
- floor of the mouth
- anterior two-thirds of the tongue
- gingiva on the lingual surface of the mandible
- gingiva on the labial surface of the mandible
- mucosa and skin of the lower lip and chin.
To ensure proper payment, back up your medical billing claim with the proper documentation to show the reason for the facial or dental block and that will allow the carrier to see why this code was chosen along with the necessity of the procedure. This will enable you to realize reimbursements instead of rejections on these type of claims.