Wiki SphenoMed Sphenocath

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celcano

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Does any one have any experience with SphenoMed Sphenocath. My physician has been approached regarding using the Sphenocath as a therapeutic procedure for headaches/migraines. We were told the billing codes are 64400-50 and 64505-50. Suggested billing dx's are 338.29 as primary dx and 346.90 or 350.1 as secondary dx's.

We were told Medicare covers this, but they are "working" with the commercial carriers. Medicaid will not cover it at this point.

Any experiences you can share or words of wisdom are appreciated.
 
64505 describes an "injection". The Sphenocath utilizes a transnasal approach to apply local anesthetic topically.
The AMA through its knowledgebase (KB#5436) offers this response to reporting a transnasal approach to the sphenopalatine ganglion:

"According to our CPT Advisors and from a CPT coding perspective, it would not be appropriate to report code 64505, Injection, anesthetic agent; sphenopalatine ganglion, as this code represents a procedure requiring the performance of an "injection". Therefore, the insertion of the Lidocaine soaked Q-tip in the nostril is not reported separately by any specific CPT code, and would be considered inclusive of an appropriate level E/M, as appropriate. Alternatively, if performed in the absence of an accompanying E/M service, the unlisted code 30999, Unlisted procedure, nose, or 64999, Unlisted procedure, nervous system, should be reported. Respectfully, CPT Education and Information Services."
 
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