Neurology & Pain Management Coding Alert

Neurology & Pain Management Coding:

Ace Autonomic Nerve Injection Encounters With These Codes

Question: If the physician performs an autonomic nerve injection of an anesthetic agent, is there a CPT® code that corresponds with the service, or should I report 64999? I don’t see any codes that match.

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Answer: You should not report 64999 (Unlisted procedure, nervous system). You should never report an unlisted code when there are codes that represent the service — and, in fact, there are a slew of autonomic nerve injection codes in the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System section of the CPT® code book.

spinal block

Do this: Go back and check the notes; then, choose from the following codes:

  • 64505 (Injection, anesthetic agent; sphenopalatine ganglion)
  • 64510 (… stellate ganglion (cervical sympathetic))
  • 64517 (… superior hypogastric plexus)
  • 64520 (… lumbar or thoracic (paravertebral sympathetic))
  • 64530 (… celiac plexus, with or without radiologic monitoring)

Exception: CPT® has separate guidance solely for 64530. There is a note under 64530 that reads: “For transendoscopic ultrasound-guided transmural injection, anesthetic, celiac plexus, use 43253 [Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)].”

Chris Boucher, MS, CPC, Senior Development Editor, AAPC