# Ganglion impar block help



## Lindseywingate1990

Dose anyone know or have any information on coding a Ganglion impar block? i have seen were some people use 64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic). i dont know if this is correct i see where some people have said to use the 64999. the doctor is choosing 64520 but i am still not sure here is the OP report:


a skin wheal was raised above the coccygeal sacral ligament and disks. a 25 gauge 2 1/2 inch chiba needle with a slightly bent tip was advanced through the skin wheal and under careful floroscopic control advanced through the sacral coccygeal ligament and just past this joint or disk space in the presacral area under lateral floroscopy i injected omnipaque and finally the patient recieved 4 cc of bupivacaine plus 25 mg of ketamine 


any advice? they also did a coccygeal block with this as well.


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## dwaldman

Below is from a previous post to a similiar question from this forum, which I found by typing in a internet search: ganglion impar AAPC


marvelh  
Guru   Join Date: Apr 2007
Location: Denver Colorado
Posts: 105 

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The ganglion impar is found anterior to the coccyx and is the only unpair sympathetic ganglion. Commonly it is injected for diagnosis of rectal pain due to tumor, trauma, etc. 

Currently there is no CPT code for either an injection of destruction of the ganglion impar. Per Sept 2007 CPT Assistant: report 64999 for an injection of the ganglion impar.


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## dwaldman

If you are reporting for the ganglion impar 64999 I don't know if they will separately recognize payment for the coccygneal nerve block. I not familiar enough with the anatomy to know exactly what to suggest when both are performed. 


Code 64450, Injection, anesthetic agent; other peripheral nerve or branch, could be reported to describe a “coccygeal nerve block”


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## dwaldman

It would be important to point out to the physician that 64520 is inappropriate code selection for the ganglion impar block. Due to the fact there is a published article from AMA CPT Assistant stating this block is unlisted. 

AMA CPT Assistant
  September 2007 page 10
Coding Communication:Surgery: Nervous System

Question: What is the appropriate CPT code to report for a ganglion impar sympathetic block? 

Answer: Code 64999, Unlisted procedure, nervous system, should be reported. When reporting an unlisted code to describe a procedure or service, it will be necessary to submit supporting documentation (eg, a procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service. 


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## Lindseywingate1990

thanks for all of the information. i will let them know! i am thinking these two procedure are going to be global to eachother because they are in the same area so i will probably just use the 64450 for the coccygeal block instead of 64999 and 64450.


thanks!!!


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## dwaldman

I would confirm with the physician what was the primary procedure or comprehensive service, if it is the ganglion impar then I would use 64999. If they would review the note and it is describing a ganglion impar block and you are reporting 64450, this could be issue if there is minimal reference to the coccygneal block or if the ganglion impar block was the primary treatment and coccygneal block was incidental.


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