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G234
G234 – Percutaneous cervical sympathetic nerve block or Stellate ganglion block - without ultrasound or fluoroscopic guidance, unilateral
OHIP Diagnostic & Therapeutic Procedures Code — DIAGNOSTIC AND THERAPEUTIC PROCEDURES · Schedule of Benefits
G234 is a unilateral percutaneous cervical sympathetic nerve block or Stellate ganglion block performed without the use of ultrasound or fluoroscopic guidance. It is mutually exclusive with G920 (the same procedure performed with guidance) on the same day for the same patient. This service is intended for sympathetic nerve injections and any sympathetic blockade resulting from other types of blocks (e.g., epidural, spinal) is not payable under this code.
When to Use
- Use G234 when performing a landmark-guided stellate ganglion block for chronic pain syndromes like Complex Regional Pain Syndrome (CRPS) or Raynaud's phenomenon.
- Use G234 for diagnostic sympathetic blocks where imaging guidance is not clinically required or available.
Common Pitfalls
- Billing G234 alongside G920 on the same day is a hard rejection; ensure you are not using G234 for procedures where ultrasound or fluoroscopy was actually utilized.
- Attempting to bill G234 for sympathetic blockade that occurs incidentally during an epidural or peripheral nerve block is an audit risk, as this is considered inclusive of the primary procedure.
- Exceeding the 24-service annual limit for the combined total of G234 and G920 will trigger automatic denials unless prior authorization is documented.
Billing Tips
- If you utilize alcohol or sclerosing agents during the block, remember to append E445 to receive the 50% fee premium.
- Ensure your clinical notes explicitly state that the block was performed without imaging guidance to justify the use of G234 over the higher-valued G920.
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