APRIL 2011

Sympathetic Nerve Blocks

Sympathetic nerves are part of the autonomic nervous system. These nerves control functions of the body’s organs that occur naturally or “automatically”. For example, when a person becomes frightened or is exercising the heartbeat increases and when that person relaxes the heartbeat will decrease and become normal again. These functions are controlled by two sets of nerves, more specifically the sympathetic nerves control increases in body organ functions (excited state) while the parasympathetic nerves control the decrease in organ functions (relaxed state).

The symptoms of reflex sympathetic dystrophy are directly associated with the sympathetic nervous system and usually caused by an injury to the affected limb (burning/tingling, coolness or bluish color of the limb because the blood vessels are constricted, and sweating due to dilation of the sweat glands). One method of treatment would be a sympathetic nerve block. An injection in the cervical region would be reported with CPT code 64510. With all of the other pain management procedures the cervical and thoracic regions are usually represented by same code (62310 for cervical/thoracic epidural or 64490 for cervical/thoracic facet), but code 64520 is for a paravertebral sympathetic block to either the thoracic or lumbar regions and this is the only instance, that I’m aware of, where the thoracic and lumbar regions are grouped together in one code. A sympathetic block is a unilateral procedure and can be reported with the appropriate bilateral modifier(s) when injections are performed on each side of the spine. Based on information from CPT Assistant Dec. 2010 – sympathetic blocks can be reported for each level that is injected. When the physician performs “incremental” injections at L2, L3 and L4, CPT code 64520 can be reported three times and when utilized, fluoroscopic guidance would be reported with code 77003-TC.
ADDENDUM TO SHOULDER PROCEDURES WEBINAR

During the Shoulder Webinar, I presented information from CPT Assistant which indicated that an acromioplasty 23130 would not be reported in addition to the open rotator cuff codes 23410/23412 and informed everyone that we had queried the AMA for an update since the AAOS Global Service Data Guide did not consider these procedures to be components of each other. In the AMA’s reply they agreed with the AAOS position and indicated that it is appropriate to report both a 23410/23412 with 23130 when these services are performed on the same shoulder. However, CCI edits do bundle 23130 into 23410/23412 so this code would not be additionally reported when billing Medicare patients.
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