Neurology & Pain Management Coding Alert

Question: We have begun providing sphenopalatine ganglion block. This is not an injection, but involves putting a topical anesthetic on a cotton swab and placing that in the patient's nose to numb a nerve. What is the appropriate code for this?

New Jersey Subscriber

 Answer: The sphenopalatine ganglion is the largest aggregate of neurons in the head outside of the brain. The ganglion is in the sphenopalatine (pterygopalatine) fossa and is accessible through the nasal cavities. Blocking of the nerve effectively treats a wide variety of pain conditions, from headache to low back pain.

 The closest available code choice to describe this procedure is 64505* (Injection, anesthetic agent; sphenopalatine ganglion), but the code descriptor specifies "injection" only. Because CPT and CMS guidelines discourage reporting the "next best" code to describe procedures not listed in CPT, the appropriate code choice is probably 01999 (Unlisted anesthesia procedure[s]). Because payers are reluctant to reimburse anesthesia codes for anyone other than an anesthesiologist, you might wish to contact the payer ahead of time and ask for advice on reporting the procedure. Be sure to provide full documentation describing the procedure and comparing it to the closest available code (64505).