Neurology & Pain Management Coding Alert

Question: Our pain management specialist administered a sphenopalatine ganglion block. Does CPT® include a code for this type of block, or do I report an unlisted procedure? If I must choose "unlisted," what's an appropriate code for comparison?

Arkansas Subscriber

Answer: Physicians can use either an injection of the medication or a topical approach, typically using long cotton-tip applicators inserted into the nose, for this type of block, so verify his documented technique before coding.

If he administered an actual injection, report 64505 (Injection, anesthetic agent; sphenopalatine ganglion).

Topical option: Some providers don't separately bill for the topical approach; they include it as part of their E/M service in counseling the patient on how to perform the technique at home. If you're justified in billing the topical approach, report 64999 (Unlisted procedure, nervous system). You can associate it with 64505 for reimbursement comparisons, with a reduced value of 2.95 RVUs.