# Coccyx injection or nerve block???



## Melissa Harris CPC (Apr 28, 2014)

Hello,

Can someone review the below procedure note and tell me if this is a coccyx injection (and what is the appropriate code) or a coccyx nerve block?? I believe it is only the injection. The office I work at has been coding a nerve block. 

PROCEDURE: COCCYX INJECTION

DIAGNOSIS: 722.52 - Intervertebral Disc Degeneration Lumbar, 724.2 - Lumbago, 729.2 - Neuralgia Neuritis & Radiculitis Unspec
INDICATIONS: BACK AND LEG 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 1mL 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 1 ml of 300mg/ml of Omnipaque before a 1 mL mixture of 2 mL .25% Marcaine, 2 mL 1% Lidocaine, and 1 ml of 40 mg/mL Kenalog was injected. The needle was then walked downward to the mid-coccyx region where another 1 mL of the above mixture was injected. The needle was again walked downward to the distal coccyx where the remaining injectate was injected after aspiration revealed no blood. 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.


I greatly appreciate your input! 

Melissa Harris, CPC


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## fdeffendoll (Apr 28, 2014)

Coccygeal Nerve Block is what I am seeing in the procedure note. What CPT have they been coding for this type of procedure?


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## dwaldman (Apr 28, 2014)

Might need to  with the physician if this was ganglion impar injection which is unlisted CPT 64999. Or if this is a sacrococygeal joint/junction injection under CPT 20600. It doesn't specifically state this is a coccygeal nerve block 64450.

I am not familiar enough with documentation of these types of injection to determine which one it is. below describes injection in this region.


"Injections used for coccydynia include corticosteroid injections into the caudal epidural space or into the sacrococcygeal junction.1 Alternatively, local anesthetic injections can block the ganglion impar (ganglion of Walther).2,3 The most direct technique to reach the ganglion impar is by the posterior approach, via inserting a thin (25 gauge) spinal needle through the sacrococcygeal junction/disk or through the first intracoccygeal junction, so that the tip of the needle reaches just anterior to the junction (as shown fluoroscopically in Fig. 1). Next, injecting contrast further confirms appropriate placement (Fig. 2) because the contrast pattern remains just anterior to the coccyx and sacrum, where the ganglion impar is located, and seems neither intravascular nor too far anterior into the rectum. Next, local anesthetic is injected, thus blocking the ganglion impar."


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## ctown (May 12, 2014)

I bill the coccyx injections with 20610.


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## dwaldman (May 12, 2014)

ctown,

The coccyx is not a major joint (hip, shoulder, knee) so I don't believe 20610 would be supported.


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