Neurosurgery Coding Alert

Question: When the surgeon performs an autonomic nerve injection with an anesthetic agent, how should I report the encounter? Can I report the anesthetic agent separately?

Oregon Subscriber

Answer: You’ll report a code from the CPT^® code book that is dedicated to autonomic nerve injections with an anesthetic agent. You cannot report a separate code for the anesthetic agent.

Do this: Go back through the notes and check what anatomical area the surgeon injected. Then, choose from one of 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)

Note: At the bottom of the code set, CPT^® includes this qualifier: “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)].

So, let’s say the surgeon treats a patient with cervicocranial syndrome. They inject an anesthetic agent into the superior hypogastric plexus (the bundle of nerves at the L1/S1 vertebral junction). On the claim, you would report 64517 with M53.0 (Cervicocranial syndrome) appended.

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