by Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
July 31st, 2014
The sphenoplatatine ganglion, more often referred to as the pterygopalatine ganglion (also Meckel’s ganglion or nasal ganglion) is located within the pterygopalatine fossa.
You can locate that place by putting your fingers at the temporomandibular joint in front of your ears and then slightly moving your fingers up until they fall into a tiny space. This is the pterygopalatine fossa. Within this fossa lies the pterygopalatine ganglion, which is a very large bundle of nerves.
This nerve bundle can become sensitive from infection, trauma or other problems and as such can cause severe pain.
Diagnosis and Treatment:
Sphenopalatine ganglion block is used for both diagnostic and therapeutic treatments to treat facial pain, mixed-type headaches (cluster, migraine, etc), and myofascial pains in the neck and upper back.
Traditionally there have been two ways to perform the procedure:
- Using a transnasal approach, the nasal turbinates are anesthetized using a spray, followed by canalization of the nose into the upper posterior wall of the nasopharynx where an anesthetic is infiltrated into the back of the nose.
- Cotton swab applicators, soaked with lidocaine, are inserted into the nostrils and advanced to the back of the nose in a perpendicular fashion, until they cannot be advanced any further. These are left in position for approximately 40 minutes until the medication is absorbed through the mucous membranes, anesthetizing the sphenopalatine ganglion.
Both of these procedures are not very comfortable for the patient.
Now, a third and more advanced technique is being used to perform the sphenopalatine block. The Sphenocath is an ergonomic device with an advanceable and retractable catheter. With the use of image guidance (fluoroscopy and contrast), the tip of the catheter can be positioned with exactness allowing for a more accurate placement of the lidocaine.
Since there are several ways to perform the sphenopalatine ganglion block, it is important to read the procedure report carefully to look for the method used and to determine if it was performed unilaterally or bilaterally.
All approaches are reported using the following codes:
Bilateral 64505-50 or with RT and LT modifiers depending upon the insurance company.
Imaging is considered incidental to the procedure and would not be reimbursed. If the procedure is performed in your office or ambulatory care center and you have purchased the Sphenocath for the procedure, be sure to charge for it.
You always want to show medical necessity for any services provided and for the sphenopalatine ganglion block, any headache, migraine or cluster-type or mixed-type headaches are appropriate along with facial pain or myofascial upper back and neck pain.