# Epidural for sympathetic continuous block



## kimberly becker (Nov 25, 2014)

Looking for ideas if anyone knows which code to use. Pt. has RSD of the leg. Dictation notes say that the epidural needle was introduced at the L4-L5 level. 64520 does not say continuous, and I have ruled out 64449 because distaction does not specify lumbar plexus.


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## Amy Pritchett (Nov 25, 2014)

Kimberly:
Without seeing the OP note, I cannot give you too much detail. I do, however know that the CPT code for indewelling catheter placement for intrathecal or epidural drug infusion with sub-q reservior codes out to 62319 and 62360. Like I said, I would have to see the OP report to really guide you in the right direction for this.


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## kimberly becker (Nov 26, 2014)

*Op report continuous block*

Thanks for your response Amy. I hope you have an idea what I can use for a continuous code.

Plan: Proceed with a sympathetic block using an epidural with Ropivacaine and Fentanyl and a continuous infusion for 12 hours. Pt. will have an I.V. placed, epidural placed and Foley catheter and continuous monitoring during epidural infusion.

Procedure: Epidural with Ropivacaine and Fentanyl infusion for sympathetic block at the level of L4-L5 with catheter placemnet and continuous infusion.

Pt. had an inravenous line started in left arm. A local anesthetic was given at the level of L4-L5 midline. Epidural needle was introduced at the level L4-L5 midline. Needle advanced into the epidural space. Epidural catheter was advanced to 4 cm. Catheter was taped in place. Infusion of Ropivacaine w/Fentanyl was started, epidurally. Infusion started at rate of 12mg. per hour basal rate and 3 mg. PCA dose every 15 minutes. Pt. will have continuous monitoring.


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## Amy Pritchett (Dec 2, 2014)

Thanks for the OP report. That is the correct code for this situation


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## kimberly becker (Dec 2, 2014)

*Op report*

Thank you so much Amy for your feedback. I have never had to use those codes before. I will remember where they are next time in my RV Guide.


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## hgolfos (Dec 3, 2014)

I would caution you against using 62319 here.  The CPT guidelines at the beginning of this section state: 

"The placement and use of a catheter to administer one or more epidural or subarachnoid injections *on a single calendar day* should be reported in the same manner as if a needle had been used, ie, as a single injection using either 62310 or 62311.  Such injections should not be reported with 62318 or 62319. Threading a catheter into the epidural space, injecting substances at one or more levels and then removing the catheter should be treated as a single injection (62310, 62311). If the catheter is left in place to deliver a substance(s) over a prolonged period (ie, *more than a single calendar day*) either coninuously or via intermittent bolus, use 62318, 62319 as appropriate."  

Since your note states clearly that the infusion was less than a calendar day, I don't think 62319 would be appropriate.


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