# Ganglion Impar RFA



## celcano (May 14, 2018)

Good afternoon, all,
My physician did an ganglion impar RFA and billed with code 64680, which is for a celiac plexus ablation.  I thought at first he had inadvertently "clicked" on the wrong code, so I queried him.  He responded:  "This was a sympathetic nerve ablation so I assume that this code is correct."  I'm still not sold.  I have searched on the internet and didn't find anything.  I am leaning toward having to bill this with 64999, but I need to convince my physician that 64680 is not correct.  Which of us is wrong?  If 64680 is incorrect, can you provide me with the reasoning why.  Any assistance will be greatly appreciated.
Thank you!


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## dwaldman (May 15, 2018)

Since the nerve block portion of the ganglion impar is unlisted, I would believe the radiofrequency ablation would be too. 

The area targeted would have to fall under celiac plexus to use 64680 unless there was specific documentation from AMA CPT Assistant or the insurance carrier stating it is appropriate to apply this code for the procedure in question. 


64680
Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus

For example AMA CPT Assistant stated in 1999 that nerve destruction procedure of the splanchnic nerve could be reported with 64680. Here is example of specific instructions supporting alternative uses of the code 64680. But like code 
64681 Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus unless there is some clear documentation stating that a code can be used that does not corresponded directly to the code descriptor, I don't believe the decision tree would lean towards 64680 more than it would 64999 for a ganglion impar RFA

February 1999 page 10
Coding Consultation

Surgery Nervous System, 64680 (Q&A)

Question

How do I report a procedure where the splanchnic nerve is injected with phenol?

AMA Comment

Since the splanchnic nerve is part of the celiac plexus, and phenol is a neurolytic agent, you should report CPT code 64680, Destruction by neurolytic agent, celiac plexus, with or without radiologic monitoring.


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## celcano (May 16, 2018)

Thank you for your assistance.  Code 64999 is what I felt was probably the correct code.


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