# Coccyx Injection and Ganglion Impar Block



## Melissa Harris CPC (Mar 10, 2014)

Hello,

I need some help coding the below procedure.  I think it may be 20605 for the injectio and 64999 for the ganglion impar block? But I am not sure.  Any help is greatly apprecitaed.

PROCEDURE:  COCCYX INJECTION AND SEPARATE GANGLION IMPAR BLOCK


DIAGNOSIS:   729.2 - Neuralgia Neuritis & Radiculitis Unspec, 724.79 - Coccyx Disorder Other
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 3.5 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 4 ml of 300mg/ml of Omnipaque.   2.5 mL a mixture of 4 mL .25% Marcaine, 4 mL 1% Lidocaine, and  2 ml of 40 mg/mL Kenalog was injected.  The needle was then walked downward to the mid-coccyx region where another 2.5 mL of the above mixture was injected.  The needle was again walked downward to the distal coccyx where 2.5 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.


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## hgolfos (Mar 10, 2014)

Those are the codes we use.


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