Sphenopalatine Ganglion Block with Medication Delivery

Question:

One of our physicians is using a device to deliver medication through the nose when a sphenopalatine ganglion block is performed under fluoroscopic guidance for patients with migraine headaches.  Can we report 64505 for this service?  If not, what is the best code to report?

Answer:

 There is no specific CPT code that accurately describes the service.  The code set includes CPT code 64505, which describes the injection of the sphenopalatine ganglion; however, it is inappropriate to report this code since an injection is not performed. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported. 

Another variation on blocking the sphenopalatine ganglion is using a Q-tip to apply anesthetic topically through the nose. There is no specific CPT code for this procedure, which is best reported as part of the E/M service. 

*This response is based on the best information available as of 10/17/24.

Paraspinal Intramuscular Injections

Question:

The type of injections our physicians perform are best described as paraspinal intramuscular injections or paraspinal nerve blocks without radiographic guidance. We are unsure how to code this procedure. What is the best code to use?

Answer:

Any injection around the spine without imaging guidance is best described as a trigger point injection.  The number of muscles injected determines whether CPT code 20552 (1 or 2 muscles) or CPT code 20553 (3 or more muscles) is billed.  If one muscle is injected multiple times, it should be coded with the lower code 20552.

*This response is based on the best information available as of 9/16/24.

Fall Risk Prevention Program: Part 2

Question:

We read and received your recent Coding Coach on the Fall Risk Prevention Program and directive to report Category II CPT codes for this service. We have a follow-up question.  Why would we not be able to report CPT code 97750 for this service, and can this code be billed incident-to the physician if the MA performs the work?   

Answer:

Per CPT coding guidelines, many parameters are associated with reporting CPT code 97750. CPT code 97750 is not used for a MIPS tracking code. Reporting this code requires that the work be performed by an MD, DO, or PT. An MA may not perform the work associated with this code and bill incident - to, as an MA is not a Qualified Healthcare Professional (QHP). 

*This response is based on the best information available as of 9/16/24.

Splanchnic Nerve Injection

Question:

We are unsure what CPT code to use when our physician injects the splanchnic nerve with phenol. Is this an unlisted CPT code? 

Answer:

Since the splanchnic nerve is part of the celiac plexus, and phenol is a neurolytic agent, you should report CPT code 64680, Destruction by neurolytic agent, celiac plexus, with or without radiologic monitoring. (For an injection of other substances such as an anesthetic and/or steroid, not a neurolytic agent, use code 64530 Injection, celiac plexus).

*This response is based on the best information available as of 9/9/24.

Fall Risk Prevention Program: Part 1

Question:

We want to institute a Fall Risk Prevention Program in our practice to take advantage of CMS's Merit-based Incentive Payment System (MIPS). Based on CMS’s 2024 Quality Measures List, what codes should we report, and can our practice's medical assistant (MA) capture this work? 

Answer:

It is great that your practice will institute a Fall Risk Prevention Program to capture MIPS. According to CMS’s 2024 Quality Measures list, there are 2 measures reportable in this category. 

Quality measure number 155 - Falls: Plan of Care. This measure is designed to capture the percentage of patients aged 65 years and older with a history of falls who had a plan of care for falls documented within 12 months. 

Quality measure number 318 – Falls: Screening for Future Fall Risk. This measure is designed to capture the percentage of patients 65 years of age and older screened for future fall risk during the measurement period. 

Per CPT, these quality measures should be reported with Category II tracking codes, which are used for performance measurement. 

The applicable category II CPT codes for these MIPS measures are as follows: 

• 1100F: Patient screened for future fall risk; documentation of 2 or more falls in the past year or any fall with injury in the past year (GER). 

• 1101F: Patient screened for future fall risk; documentation of no falls in the past year or only 1 fall without injury in the past year (GER). 

An MA can capture the work to assist the clinician when reporting these Category II CPT codes. 

*This response is based on the best information available as of 9/5/24.

Transcutaneous Magnetic Nerve Stimulation

Question:

How is this service reported, we are having trouble locating a CPT code, should we use an unlisted code?

Answer:

This service should not be reported with an unlisted code.New Category III codes were created in 2023 to report transcutaneous magnetic nerve stimulation of peripheral nerve by focused low frequency electromagnetic pulse with noninvasive electroneurographic localization. This new technology is used in the management of chronic pain following a traumatic injury. The treatment is repeated over several months. Injured nerve is localized using magnetic stimulation at the time of the initial treatment. The skin is marked with photographic record to facilitate rapid localization of the correct site for subsequent treatments and the appropriate amplitude of magnetic stimulation.  

Nerve conduction may be used as guidance to confirm precise localization of the injured nerve but is not separately reported as a diagnostic study. If a separate diagnostic nerve conduction study is performed prior to the decision to treat with transcutaneous magnetic stimulation, then it may be reported separately.  

• 0766T Transcutaneous magnetic stimulation by focused low frequency electromagnetic pulse, peripheral nerve, initial treatment, with identification and marking of the treatment location, including noninvasive electroneurographic location (nerve conduction location) when performed; first nerve  

• +0767T Each additional nerve (List separately in addition to code for primary procedure 

*This response is based on the best information available as of 7/11/24.