778 - Top 10 Nerve Blocks Every Interventional Radiologist (IRs) Should Know to Bill For

Learning Objectives: 1. Summarize indications, anatomic targets and techniques for top 10 nerve blocks used in IR

2. Identify CPT codes and billing considerations for each block.

3. Provide guidance on documentation and imaging requirements to support reimbursement.

Background: Analysis of 2015 Medicare Part D data shows most IRs (52.2%) wrote ≤10 prescriptions, and among those writing more than 10, most wrote opioids and prescribing patterns varied by physician and practice characteristics {1}. Interventional pain management is indicated when opioids must be minimized, when analgesics fail or when access to medication is limited {2}. Nerve and plexus blocks, neurolytic procedures and other interventions are often the only options and are primarily performed by IR {2}. Resource shortages and long wait times can lead to high opioid doses; effective procedures require careful opioid tapering, training and collaboration {2}. These findings reflect the shift from opioid reliance to multimodal analgesia and IR.

Clinical Findings/Procedure Details: Understanding nerve blocks for billing requires matching indications to CPT codes and recognizing coverage differences. Peripheral nerve blocks (femoral, sciatic) are mainly used for perioperative analgesia and trauma; payers often cover them under anesthesia but reserve interventional coverage for cancer or diagnostic indications. Paravertebral and intercostal blocks treat rib fractures and thoracic tumors; IR can bill for trauma or cancer, while anesthesia usually bills for perioperative use. Celiac, superior hypogastric and ganglion impar blocks for cancer pain are strongly reimbursed in IR; stellate and lumbar sympathetic blocks for CRPS or ischemia have shared coverage. TAP blocks, used for abdominal surgery, are often bundled into surgical global fees, limiting separate reimbursement. Optimizing coding involves selecting the correct CPT codes and understanding payer‑specific bundling rules and restrictions on repeated chronic use.

Conclusion and/or Teaching Points: Interventional radiologists can lead the shift to opioid‑sparing pain management. Expertise in nerve block indications, technique and coding ensures effective analgesia and appropriate reimbursement {3}.