Reader Question:
Look to 'Unlisted' for Stellate Ganglion Destruction
Published on Thu Aug 09, 2007
Question: What code should we use for neurolytic destruction of the stellate ganglion? Does a diagnosis of complex regional pain syndrome indicate medical necessity for the procedure? I can't find any information in our Medicare carrier's local coverage determination that addresses this.
Washington Subscriber
Answer: You're not alone -- many coders are unclear regarding the best choice for this procedure. Code 64510 (Injection, anesthetic agent; stellate ganglion [cervical sympathetic]) is incorrect because it represents a nerve block, not destruction, and 64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level) is also incorrect -- the code represents a somatic nerve, but the stellate ganglion is a sympathetic nerve. Your physician is treating the same anatomic area, but not the same anatomic structure, so 64626 doesn't apply.
Unlisted option rules: Because these coding options are inaccurate -- and because CPT doesn't include more accurate codes for the procedure -- your best choice is 64999 (Unlisted procedure, nervous system). Include documentation that explains the procedure your physician completed and any other supporting information.
