Ganglion Impar Injection

Question:

What is the correct code to report when our physician performs a ganglion impar injection with Depo-Medrol and Lidocaine? 

Answer:

The most appropriate code for this procedure is unlisted. However, as with all pain injections, check your payor policies regarding specific coverage. 

*This response is based on the best information available as of 4/25/24.

Genicular Nerve Injection

Question:

What is the correct code (s) to report when the physician injects the superomedial and superolateral branches of the genicular nerve for knee pain with a steroid?

Answer:

The correct code to report for this service is 64454 (Injection (s), anesthetic agent (s) and/or steroid; genicular nerve branches including imaging guidance, when performed) with modifier 52 (Reduced Services). If all 3 nerve branches of the genicular nerve (superolateral, superomedial, and inferomedial) are not injected the service is reported with modifier 52. CPT code 64454 should not be used to report a piriformis injection. Piriformis muscle injection(s) should be reported using CPT code 20552, Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

*This response is based on the best information available as of 4/11/24.

Piriformis Muscle Injection

Question:

We perform Piriformis muscle injections in the office under ultrasound guidance, what code should we be reporting for this service? 

Answer:

The correct code(s) that should be reported for the service are 20552 for the piriformis muscle injection and 76942 for the ultrasound guidance. 

Rationale: Per CPT Assistant April 2012  

There is a significant difference in the work and procedure, as well as intent, between an injection of the piriformis muscle and the perineural injection of the sciatic nerve. The sciatic nerve injection code (64445) should not be used to report a piriformis injection. Piriformis muscle injection(s) should be reported using CPT code 20552, Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s). 

*This response is based on the best information available as of 3/28/24.

Sphenopalatine Ganglion Block

Question:

How do I report a ganglion impar injection of Depo-Medrol and Lidocaine? 

Answer:

The most appropriate code for this procedure is unlisted. However, as with all pain injections, check your payor policies. Some policies consider a ganglion impar injection, specifically for rectal or pelvic pain, as not medically necessary. Others allow payment with an unlisted code. Using an existing code such as 64450, other peripheral nerve, without knowing the payor’s policy may get reimbursed inappropriately.

*This response is based on the best information available as of 3/14/24.

New to Pain Management

Question:

Pain Management is a brand-new service line for our practice, we have 20 Orthopaedic surgeons (one is interventional ortho/pain management).  We just purchased a C-Arm and are using it in the office.  The pain management surgeon was using this at the outpatient surgical facility.  Is there anything specific regarding billing for the C-Arm for place of service 11 (office) that we should be aware of? 

Answer:

KZA recommends that you reach out directly to the specific insurance carriers that you are contracted with regarding coverage and reimbursement of the C-Arm.  Most pain management procedures include the use of C-Arm in the performance of the procedure and therefore, the use of the C-Arm would not be reported in addition. KZA also recommends you check your Medicare Administrative Contractor (MAC) for specific Local Coverage Determinations (LCDs) for any pain management procedures your clinic will be performing. The LCDs provide information regarding the coverage criteria, requirements, and medical necessity for the procedure(s). 

*This response is based on the best information available as of 2/29/24.

ARNP Billing Inquiry

Question:

We have an ARNP joining our practice, can you please confirm which pain management procedures they are allowed to perform.  Are they allowed to perform all procedures except RFA procedures?

Answer:

The answer to your question will depend on the NP scope of practice for your state so you will need to research this information for your state.  In addition, check provider qualification requirements with your commercial payors and your MAC. The LCDs for Facet Joint Injections Epidural Steroid Injections, and Nerve Blocks for Chronic Pain and Neuropathy list the provider qualifications.

*This response is based on the best information available as of 2/15/24.