SPG block billing

[thecentral09]

Hey, I have a very miserable headache pt. Has tried everything including cervical decompression and meningioma resection to cure headache. That part doesn’t matter, but SPG block is literally only thing he hasn’t tried. Medicare. Any one doing them, how to bill? Is it a reimbursable code? Any help appreciated!

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[Orin]

CPT 64505 is normally accepted although many insurances argue it should be 64999

I assume it'll get coded as a 64999 and try to do this as cheaply/simply as possible with a spritz of lidocaine with a blunt tip needle or angiocath into the nose while supine, asking the patient to cough/blow their nose to aerosolize it back up and not onto the oropharynx.

I would argue that the little history you've provided does matter as this is a patient grasping at incidentalomas with likely a degree of anxiety/rumination and desire to be definitively fixed. What is the headache pattern?

 

[callmeanesthesia]

Bill 64999. Medicare in my area is pretty explicit that you can’t bill 64505

https://med.noridianmedicare.com/documents/10546/12461373/Billing+Medicare+for+the+SphenoCath+and+Other+Similar+Devices

This is my preferred technique:

Images in Anesthesiology: Modified Cotton Swab Applicator for Nasal Sphenopalatine Ganglion Nerve Block

THE modified cotton swab applicator assembled from ubiquitous components found in most operating rooms is an alternative to costly commercial devices (Tx360 [Tian Medical, LLC, Grayslake, Illinois] and Sphenocath [Dolor Technologies, LLC, Salt Lake City, Utah]) for sphenopalatine ganglion nerve...

pubs.asahq.org

Quick and cheap, since you probably won’t get paid (much) for it anyway. Can also Rx lidocaine and have patient self-administer by putting in a dropper bottle, laying back with head extended over a pillow, and dripping about 1 mL down each nostril and letting it sit for 10 minutes or so.
You’re probably better off finding a med to refill or another problem to discuss and just billing for the office visit...

 

[soccrwz]

how do you write the lidocaine ( what % do they carry), is this available at most pharmacies?

 

[callmeanesthesia]

how do you write the lidocaine ( what % do they carry), is this available at most pharmacies?

Plain 1% with preservative. Hard to find a pharmacy to dispense it though. Sometimes have to call around to several (or have the patient do it but they usually get the blow-off).

 

[thecentral09]

Bill 64999. Medicare in my area is pretty explicit that you can’t bill 64505

https://med.noridianmedicare.com/documents/10546/12461373/Billing+Medicare+for+the+SphenoCath+and+Other+Similar+Devices

This is my preferred technique:

Images in Anesthesiology: Modified Cotton Swab Applicator for Nasal Sphenopalatine Ganglion Nerve Block

THE modified cotton swab applicator assembled from ubiquitous components found in most operating rooms is an alternative to costly commercial devices (Tx360 [Tian Medical, LLC, Grayslake, Illinois] and Sphenocath [Dolor Technologies, LLC, Salt Lake City, Utah]) for sphenopalatine ganglion nerve...

pubs.asahq.org

Quick and cheap, since you probably won’t get paid (much) for it anyway. Can also Rx lidocaine and have patient self-administer by putting in a dropper bottle, laying back with head extended over a pillow, and dripping about 1 mL down each nostril and letting it sit for 10 minutes or so.
You’re probably better off finding a med to refill or another problem to discuss and just billing for the office visit...

Thank you for the input, unfortunately I sent this to my billers and they said both codes are deemed experimental and will not be reimbursed.

 

[Ducttape]

I believe we discussed billing for SPGs on a previous thread a couple of years ago and it was clear that we cannot charge for anything other than the office visit.

 

[deleted875186]

Could you bill a 64450 ?