Anesthesia Coding Alert

Paracoccygeal Nerve Block  Question: Our pain specialist injected lidocaine without epinephrine just adjacent to the sacral hiatus on both the left and right sides. He calls it a paracoccygeal nerve block. How should we code it?

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 Answer: The coccygeal nerve is the lowest pair of 31 spinal nerves exiting from the spinal cord. Each coccygeal nerve is a small distal nerve originating off the fifth sacral nerve. Branches of the S4, S5 and coccygeal nerve form the coccygeal plexus, which innervates the skin over the coccyx and around the anus.

 Most providers consider the coccygeal nerve to be a peripheral nerve/branch. As such, they report an anesthetic block of the coccygeal nerve with 64450 (Injection, anesthetic agent; other peripheral nerve or branch).

 Another option: Injecting local anesthesia just lateral to the sacral hiatus on both sides (left and right) has limited documented efficacy. The procedure is not standard treatment, so your carrier might reject the claim. Because of this, some physicians recommend reporting 64999 (Unlisted procedure, nervous system) and including the operative notes and justification for the procedure. Check your local carriers' policies and talk with your provider to determine the more accurate option.