Anesthesia Coding Alert

Question: My pain management provider performed a GON block for a patient with severe, persistent headaches. I'm not sure how to code this based on the diagnosis. What CPT and ICD-9 codes should I use?

Nevada Subscriber

Answer: You would use 64405 (Injection, anesthetic agent; greater occipital nerve) to report a greater occipital nerve (GON) block.

Dx help: Greater occipital neuralgia produces an aching, burning, or throbbing pain, or a tingling or numbness, along the back of the head. If your pain management specialist indicates "occipital headache" as the diagnosis, be aware there is no specific listing for occipital anatomic location under "headache" in the ICD-9 alphabetic index. Use the diagnosis code 784.0 (Headache) from the "Symptoms, Signs and Ill-defined Conditions" chapter.

There are several headache codes you might encounter when coding for occipital or trigeminal nerve blocks. Clip and save this checklist if your practice regularly administers these blocks:

053.12 -- Postherpetic trigeminal neuralgia

307.81 -- Tension headache

339.0X -- Cluster headaches

339.1X -- Tension type headache

346.XX -- Migraine

350.1 -- Trigeminal neuralgia

723.8 -- Occipital neuralgia

The GON originates from the C2 spinal nerve and provides sensory innervation to the back of the scalp extending to the top of the head. Your pain management specialist will typically inject the GON just above the superior nuchal line, a low ridge that runs horizontally on the external surface of the occipital bone, for occipital or cervicogenic headaches or neck pain.

Your physician should clearly indicate the injection location in his documentation. In fact, some providers include in their documentation a small illustration that can be marked with the various injection sites. You can then ensure that you're choosing the correct nerve injection code each time.