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  • Hi Heather,
    The following is the rest of my response but there is a message length limit and had to split into 2 messages:

    Caudal epidural injections are performed via the sacral hiatus. Here is a link for an illustration of the sacral anatomy: http://anatomy.med.umich.edu/atlas/back_bone4.html

    The sacrococcygeal joint is located just below the sacral hiatus and the ganglion impar is located on the anterior side of the pelvis - anatomically anterior to the sacrococcygeal joint. Here is a link that shows this anatomy and needle placement in the sacrococcygeal joint to allow needle access for a ganglion impar injection: http://www.hpssandiego.com/ganglia%20impar.gif

    I would not be comfortable with bypassing any bundling edits with the 59 modifier, particularly since the patient is covered by Medicare
    Hello Heather,
    I have been out of the office speaking at a conference and am now working on the stack of e-mails! I don't come into the AAPC forum every day either.

    The compliant code for the ganglion impar injection remains as 64999. Anatomically, I agree that the three injections would not be considered to be performed in a separate and distinct anatomic location.

    Depending upon what was the primary procedure, the caudal epidural or the ganglion impar block, that would determine which of these two codes would actually be billed.

    Look for second response with links for illustrations

    Good luck,
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