Reporting 64405 for Third Occipital Nerve Blocks? Think Again

Also, learn what CPT codes you must choose for blocking lesser occipital nerve

Physiatrists who administer third occipital nerve blocks must not automatically assume that 64405* (Injection, anesthetic agent; greater occipital nerve) is the most suitable CPT code. Most medical coding consultants recommend reporting 64470-22 in place of 64405 to more precisely define these types of blocks.

Occipital Nerves Differ

When a physician specifies on the charge ticket that he or she carried out an occipital nerve block, your instinct might tell you to assign CPT code 64405. However 64405 is not at all times the most correct code. Physiatrists administer injections to the third occipital nerve to help diagnose and treat dissimilar forms of headache and neck pain.

The ‘third occipital nerve’ is not anatomically identical with the greater occipital nerve. Physicians use both injections to diagnose and/or treat some forms of headache. However coding hinge more on the anatomical structure and the procedure location than the patient’s symptoms or diagnosis.

The body contains three diverse sets of occipital nerves: the greater occipital, the lesser occipital, and the third occipital nerve (also referred to as the “least occipital nerve”). By reviewing the physiatrist’s documentation, you can identify which nerve he or she blocked and assign the correct code for the procedure.

The greater occipital nerve originates from the dorsal ramus of the C2 spinal nerve. It has movement (motor) functions that innervate in the posterior neck muscles and sensory functions for the skin of the posterior surface of the scalp. Physicians often inject the greater occipital nerve to diagnose and treat occipital neuralgia (723.8, other syndromes affecting cervical region). You should report CPT code 64405 for this procedure.

The lesser occipital nerve also originates from the C2 spinal nerve, but its source is the ventral ramus. It has only sensory functions that innervate the skin behind the ear. The CPT code for blocking lesser occipital nerve is 64450* (Injection, anesthetic agent; other peripheral nerve or branch).

The third occipital nerve (TON) is certainly the superficial medial branch of the C3 spinal nerve’s dorsal ramus. The TON, like the greater occipital nerve, has both motor and sensory functions. It innervates some of the neck muscles and the C2-3 facet joint. Pain stemming from this joint can be referred to the occiput and even as far as the frontal region and orbit.

Pinpoint the Correct Code

A physiatrist may inject all three occipital nerves to help diagnose or treat chronic headaches. The practitioner selects the suitable occipital nerve injection based on the patient’s medical history along with the condition (for example, a history of neck trauma such as whiplash [847.0, Sprains and strains of other and unspecified parts of back; neck], tender neck points [723.1, Other disorders of cervical region; cervicalgia], description and quality of headache, etc.).


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