Hello,

Need some feedback on coding this procedure. Just wonder if we can bill separately for the coccyx injection along with 64999 for the Ganglion Impar? Thank You
Melissa Harris CPC
The Albany and Saratoga Centers of Pain Management.

COCCYX INJECTION AND SEPARATE GANGLION IMPAR BLOCK
INDICATIONS: Coccyx pain
ANESTHESIA: Local

DESCRIPTION OF PROCEDURE: With written informed consent obtained, risk and benefits were discussed including but not limited to infection, bleeding, swelling, bone, nerve and joint damage.
The patient was then brought into the operating room with appropriate monitors in place, the patient was placed on the procedure room table in the prone position. Utilizing fluoroscopic guidance, the sacrococcygeal junction was brought into fluoroscopic Anterior Posterior view, a lateral view of the coccyx was then attained. The area was then prepped and drapped in a sterile fashion. A small skin wheel was raised directly over the sacrococcygeal junction using 1 mL of 1% Lidocaine. A 22 gauge 5 inch spinal needle was then advanced downward to the sacrococcygeal junction and entered at the first interspace. At this point after careful aspiration reveals no blood, needle placement is confirmed using 1 ml of 300mg/ml of Omnipaque. 1 mL of a mixture of 2 mL .05% Marcaine, 2 mL Normal Saline, and 1 ml of 40 mg/mL triamcinolone was injected. The needle was then walked downward to the mid-coccyx region where another 2 mL of the above mixture was injected. The needle was again walked downward to the distal coccyx where 2 mL was injected after aspiration revealed no blood. The needle was then placed at the intercoccygeal space and, once dye was used to see the ganglion impar, the remainder of the medication was injected. The needle was then removed, puncture wound was dressed. The patient was removed from the procedure room table in stable condition and brought to the recovery area having tolerated the procedure well.

Fluoroscopic Time: 0-1 minute
PRE-OPERATIVE PAIN SCORE: 7/10
POST-OPERATIVE PAIN SCORE: 7/10
VITALS DURING PROCEDURE: O2 SAT: 95% Heart Rate: 59