Ultimate IR Nerve Block & Neurolysis Reference

Purpose: This excel is a tool for individuals performing nerve blocks and neurolytic procedures. It standardizes clinical indications, anatomy and technique, CPT coding logic, coverage risk, and documentation language to support defensible decision-making, accurate billing, and consistent procedural notes in real-world IR practice.

Date Created: December 2025

Authors: Jackie Brenner, Jaclyn Lundberg

How to use this excel:

This excel is a practical reference for individuals who perform nerve blocks and neurolytic procedures.

It is designed to help you do three things reliably:

1. Decide whether a block is reasonable for a given patient

2. Document it clearly and defensibly

3. Code it in a way that minimizes audit and denial risk

How the Excel Is Organized

Each block appears across multiple sheets. You are meant to move between them depending on what question you’re answering.

Recommended Way to Use It:

Sheet-by-Sheet:

BLOCK_MASTER

This is the index

It tells you:

• What the block is called

• Whether it's central vs peripheral

• The anatomic region

• The block family (plexus, ganglion, peripheral nerve, fascial plane) 

Use this to orient yourself

CLINICAL INDICATIONS

This sheet answers: "When does this block make sense?"

Each row is one indication, with:

• Clinical context (cancer, trauma, peri-procedural, chronic pain) 

• Strength of support (high, moderate, low) 

• Policy sensitivity (low vs high risk)

This is where you quickly see which uses are routine and which are likely to be questioned.

ANATOMY_TECHNIQUE

This sheet answers: "How do I describe what I actually did?"

It gives you:

• Plain-English target descriptions 

• Billing-safe language 

• Whether laterality is required 

• Typical imaging guidance

Use this when dictating so your note clearly matches what the CPT code expects

CPT_MECHANICS

This is the coding logic sheet.

It explains:

• The correct CPT code (s)

• When add-on or continuous codes apply 

• Block vs neurolysis distinctions

• When unlisted codes are appropriate

• Whether imaging guidance is included or separate

If there is any uncertainty about coding, this sheet is meant for that

COVERAGE_REALITY

This sheet answers: "What usually gets denied, and why?"

It summarizes:

• Coverage strength by indication

• Common denial reasons

• Bundling risk (low, moderate, high) 

• The most defensible ("green zone") scenarios

This reflects real payer behavior, not theoretical coverage.

DOCUMENTATION_LIBRARY

This is the copy-paste sheet.

It contains:

• Indication language • Imaging language

• Target confirmation language • Block vs neurolysis intent statements

• Unbundling or postoperative language when needed

Use this to standardize notes and avoid vague wording that triggers audits.

REFERENCES_INDEX

This is the source list.

All citations, guidelines, CPT Assistant references, CMS/NCCI documents, and payer policies live here.