# Ipack



## pajohnson (Nov 1, 2016)

Hi all-

I am in need of some information about the IPACK.  This is new to me and I was wondering which CPT code do you use to bill with?
I know that the IPACK is used in conjunction with the adductor canal block for TKA.
Here is what IPACK stands for: Infiltration of the space between the Popliteal Artery and the Capsule of the posterior Knee.
Any help is greatly appreciated!!


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## snelson@mcw.edu (Jul 20, 2017)

Hello,

  I am researching this as well and wondering what code(s) you are using? Any info would be great!

Thank you!


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## marvelh (Jul 20, 2017)

It appears that it is a block of the popliteal nerve plexus which includes some of the genicular nerves that provide innervation to the knee.
www.youtube.com/watch?v=6A_kJTQrczk 

www.researchgate.net/profile/Jens_B...algesic-Block-for-Total-Knee-Arthroplasty.pdf - 
[INDENTInfiltration of the posterior genicular capsule as part of local infiltration analgesia (LIA) will anesthetize the capsular branches from the popliteal plexus. Selective blockade of the popliteal plexus as a perivascular approach or infiltration between the popliteal vessels and the posterior knee capsule to block the genicular contribution from the obturator and tibial nerves has not been described in the literature. However, trials are ongoing, exploring the effect of combined FT block and local anesthetic infiltration of the interspace between the popliteal artery and the capsule of the posterior knee—coined the “iPACK” principle by its originator Sanjay Sinha (personal communication).][/INDENT]

No specific code for popliteal or genicular nerve injection, so may need to look at 64450 for single injection


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## dlynes (Mar 24, 2020)

According to the AMA, because the IPACK block is directed as a tissue plane (not at a specific nerve) and blocks several nerves, it is coded to unlisted code 64999 _Unlisted procedure, nervous system. _
The ultrasound guidance may be reported with 76942 Ultrasound guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.


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## Mellaws (Jun 23, 2020)

dlynes said:


> According to the AMA, because the IPACK block is directed as a tissue plane (not at a specific nerve) and blocks several nerves, it is coded to unlisted code 64999 _Unlisted procedure, nervous system. _
> The ultrasound guidance may be reported with 76942 Ultrasound guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation.


Thank you for sharing this information. Can you share the link for the AMA reference please?


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## NoreenMM (Aug 20, 2020)

Coding Clinic for HCPCS, 4th quarter 2019, page 10 is the citation I have for using 64999.


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