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Pain Management Coding:
Only Report Add-Ons for Guidance When Appropriate
Published on Mon Oct 28, 2024
Question: A patient with alcohol-related chronic pancreatic cirrhosis reports to the pain management (PM) specialist for pain relief. The patient lies face-down on the table but is fully awake; they turn down an offer of a sedative to relax. A nurse practitioner (NP) sterilizes the patient’s skin over their back and applies local anesthesia to the affected area. Using fluoroscopic guidance, the PM specialist locates the celiac plexus. They then pass a small-gauge needle through the skin below the rib cage to the celiac plexus and inject anesthetic into the region. How should I report this encounter? Can I report the imaging separately? AAPC Forum Subscriber Answer: No, you cannot report the guidance separately. On the claim, report 64680 (Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus) for the block. Also, append K86.0 (Alcohol-induced chronic pancreatitis) to 64680 to represent the patient’s pancreatitis. Why no guidance? You might be tempted to report +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)) for the fluoroscopic guidance — but don’t. There is a list of codes you can report with +77002 beneath its descriptor, and 64680 isn’t on the list. Chris Boucher, MS, CPC, Senior Development Editor, AAPC 
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