EM Coding Alert

Question: A new patient with a dislocated right jaw is referred by the local hospital to a pain management practice for pain relief. After performing an evaluation and management (E/M) service that included low-complexity medical decision making, the physician decides to perform a block of “Meckel’s ganglion.” How should I code this encounter, and what is “Meckel’s ganglion”?

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Answer: Meckel’s ganglion is another name for the sphenopalatine ganglion, which is associated with the trigeminal nerve.

On your claim, you should report:

• 64505 (Injection, anesthetic agent; sphenopalatine ganglion) for the block
• Modifier RT (Right side) appended to 64505 to indicate laterality
• 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.) for the E/M
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to 99203 to show that the nerve block and the E/M were separate services
• S03.01XA (Dislocation of jaw, right side, initial encounter) appended to 64505 and 99203 to represent the patient’s injury

More block info: When your PM specialist blocks the sphenopalatine ganglion, they might also note it as Meckel’s ganglion — as your physician did — or nasal ganglion. Code all of these blocks with 64505.