Pain Management Coding Alert

Question: My physician is planning to do RFA (radiofrequency ablation) of the coccyx. It will be a non-pulsed procedure into the coccyx disc. I’m leaning toward coding this as 64999 instead of 64650. What do you recommend?

Nebraska Subscriber

Answer: The sacrococcygeal disc is a thin plate of fibrocartilage interposed between the sacrum and coccyx. The ganglion impar is anterior to this. CPT^® Assistant has previously published that you should code a ganglion impar block as 64999 (Unlisted procedure, nervous system). You might be able to report a coccygeal nerve block with 64450 (Injection, anesthetic agent; other peripheral nerve or branch) if your physician injected the coccygeal nerve, but not for RFA destruction of the disc. Without a specific nerve or branch documented as the target, you’ll need to report 64999 instead of 64650.