# Blocks



## pajohnson (Aug 28, 2015)

I need help on which CPT code to use for continuous adductor canal blocks?
I would normally use 64450, but i don't think that this covers continuous?
Would it be 64449?

Also, for the fascia Iliaca continuous blocks do you use 64448?

Thanks to all those you can respond quickly!!


----------



## dwaldman (Aug 30, 2015)

continuous adductor canal block----From looking at what nerve this location supports, it appears this falls under the saphenous nerve and since there is not a continuous infusion of other peripheral nerve that leave you with unlisted code 64999.

http://www.nysora.com/techniques/ul...-ultrasound-guided-saphenous-nerve-block.html

"The saphenous nerve is the terminal sensory branch of the femoral nerve"
"The nerve to the vastus medialis muscle also lies in the adductor canal (in its proximal portion"


http://www.nysora.com/techniques/ul...57-ultrasound-guided-fascia-iliaca-block.html

Ultrasound Anatomy

The fascia iliaca is located anterior to the iliacus muscle (on its surface) within the pelvis. It is bound superolaterally by the iliac crest and medially merges with the fascia overlying the psoas muscle. Both the femoral nerve and the lateral cutaneous nerve of the thigh lie under the iliacus fascia in their intrapelvic course

Distribution of Blockade

The distribution of anesthesia and analgesia that is accomplished with the fascia iliaca block depends on the extent of the local anesthetic spread and the nerves blocked. Blockade of the femoral nerve results in anesthesia of the anterior and medial thigh (down to and including the knee) and anesthesia of a variable strip of skin on the medial leg and foot. The femoral nerve also contributes to articular fibers to both the hip and knee. The lateral femoral cutaneous nerve confers cutaneous innervation to the anterolateral thigh.

_____________________
I had remember the fascia iliac block had previously been mentioned on this forum awhile back. I was able to locate that post and below here is the link/ I also copied and pasted the post where the coding for this block is mentioned:
_____________________________________________________________

https://www.aapc.com/memberarea/forums/showthread.php?t=13143

marvelh 


Some providers use the fascia iliaca block as a technique to inject the femoral nerve and lateral cutaneous femoral nerve. I would check with your physician if he was blocking the femoral nerve with this approach, if so then look at 64447 for single or 64448 for continous infusion.

 Here is one link that I found with info on the fascia iliaca block: http://www.usra.ca/upload/UIA/200711...ca Block.pdf 

 This is similar to physicians referring to a interscalene or supraclavicular block for a brachial plexus block. They are describing the technique rather than the actual nerve or plexus being injected.


----------



## LisaAlonso23 (Aug 31, 2015)

The adductor canal is approach to the femoral nerve. The correct continuous code is 64448 (64447 for single injection). 

You can use 64448 for continuous infusion for the other, but, again, the fascia iliaca is the approach to the femoral nerve. The approach is through the iliopsoas muscle, through the fascia and into the lumbar plexus nerves which are the lateral femoral cutaneous, femoral and obturartor nerves.


----------



## pajohnson (Sep 4, 2015)

Thanks for your responses.  It cleared up my adductor canal question.  But, I am stlill a little unclear about the Fascia Iliac.  I do understand that it is an approach.  But what code would you use?
Thanks


----------



## dwaldman (Sep 22, 2015)

AMA recently published in  CPT Assistant guidance for this procedure in question.

AMA CPT Assistant 
September 2015 page 12
Frequently Asked Questions:Surgery: Nervous System

Question: There seems to be a lot of confusion as to whether fascia iliaca block is reported with CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch; code 64447, Injection, anesthetic agent; femoral nerve, single; or code 64448, Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement). Which code is appropriate? 

Answer:A fascia iliaca block may be reported with code 64450. This code is utilized for the diagnostic or therapeutic introduction or injection of an anesthetic agent in a peripheral nerve or branch. It is not appropriate to report code 64450, if the injection serves to provide anesthesia for a surgical procedure


----------

