Sphenopalatine Ganglion Block Coding

19 May

Question to Healthcare Fraud Shield:

What is the proper procedure code for Sphenopalatine ganglion block?  It is not an injection, therefore 64505 is not the correct code.  It is a minimally invasive procedure, whereby an anesthetic or a neurolytic is introduced intranasally for topical administration to sphenopalatine ganglion.

Dear Healthcare Fraud Shield Reader:

Great question!  According to some advice found on justcoding.com

Our pain management physician also performs sphenopalantine nerve blocks using a lidocaine soaked Q-tip. I submitted this coding scenario to the AMA through knowledgebase (KB#5436) and the AMA replied:

“According to our CPT Advisors and from a CPT coding perspective, it would not be appropriate to report code 64505, Injection, anesthetic agent; sphenopalatine ganglion, as this code represents a procedure requiring the performance of an “injection”. Therefore, the insertion of the Lidocaine soaked Q-tip in the nostril is not reported separately by any specific CPT code, and would be considered inclusive of an appropriate level E/M, as appropriate. Alternatively, if performed in the absence of an accompanying E/M service, the unlisted code 30999, Unlisted procedure, nose, or 64999, Unlisted procedure, nervous system, should be reported. Respectfully, CPT Education and Information Services.”

If you have an AMA Knowledgebase account set up, you can search the knowledgebase for KB#5436 and find the above question and response.

Thank you!

-Healthcare Fraud Shield


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