Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that the physician performed a celiac plexus block with anesthetic agent for an established patient after a level-four evaluation and management (E/M) service. How should I report this encounter?

New Hampshire Subscriber

Answer: You will need more procedure details before you can target a code for the celiac plexus block. Confirm if your physician did a celiac plexus block or complete destruction. From the explanation provided, it is assumed that your physician injected the celiac plexus to block it. You report code 64530 (Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring) for this service.

If your surgeon does a celiac plexus destruction, you submit code 64680 (Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus).

Note: For transendoscopic ultrasound-guided transmural injection of an anesthetic agent into the celiac plexus, you submit code 43253 (Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance[s] [e.g., anesthetic, neurolytic agent] or fiducial marker[s] [includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis]).

Remember E/M-25: No matter the code you choose for celiac plexus block, remember to report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity…) for the E/M with 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) applied to prove the E/M was a significant, separately identifiable service from the block.

Why not 57? All three of the aforementioned codes — 64530, 64680, and 43253 — have global periods of 0 or 10 days, so you won’t need modifier 57 (Decision for surgery) no matter which block code you choose. You’ll only append modifier 57 to E/M services that lead to procedures with 90-day globals.