Neurosurgery Coding Alert

Question: Our provider does a sympathetic block for two different patients on the same day.  However, the documentation mentions different terminologies for the two procedures.  In one, he documented administering a lumbar sympathetic chain block and the other a lumbar sympathetic block. Are these two procedures different? What code(s) can we use to report these procedures?

Indiana Subscriber 

Answer: A lumbar sympathetic block or lumbar sympathetic chain block are essentially the same procedures. Your physician isn’t doing anything different in the two patients. You report the service with 64520 (Injection, anesthetic agent; lumbar or thoracic [paravertebral sympathetic]).

What are sympathetic nerves? Anatomically, the sympathetic nerves are a chain of nerves that run on the front side of the spinal vertebrae. 

What is a lumbar sympathetic block? Providers typically inject about 10cc per level injected, which is a much larger volume of medication than with epidural steroid injections (ESI) or facet injections. The increased volume allows the medication to spread up and down the sympathetic chain, producing an improved sympathetic block.