Radiology Coding Alert

Question: Our pain management specialist administered a neurolytic celiac plexus block and bilateral splanchnic nerve block. What CPT codes should we report?

Utah Subscriber

Answer: Submit 64680 (Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus) for this service.

Explanation: Code 64680's descriptor simplifies your choice for the celiac plexus block. The celiac plexus is a network of ganglia and nerves, including the greater and lesser splanchnic, which is why 64680 also applies to that injection. Code 64680 represents destruction; the injection typically "floods or bathes" the plexus. If your provider performed bilateral splanchnic blocks during the same setting, he likely administered the first as an anesthetic for the destruction. The anesthetic injection would not be separately billable, so you should report 64680 only once and without a modifier.

Guidance: For fluoroscopic guidance, consider whether 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) matches your documentation. CPT Assistant (June 2008) states that you should report 77002 rather than 77003 (definition below) for 64680. The reasoning is that the sort of injection 64680 describes is not included in the 77003 descriptor, so 77002 is more accurate.

The definition of 77003 has changed since CPT Assistant published that advice, but only to become even more restricted. Consequently, the advice should still apply. Here is how thecode definitions compare:

• 2008: 77003 -- Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction
• 2011: 77003 -- Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction.