# Superficial cervical plexus block CPT



## jls4567 (Apr 28, 2016)

Hi All,
I am in need of a CPTcode for a superficial cervical plexus block for post operative pain management. Along with any supporting links
I checked with the physician and it does not meet the criteria for the 64413.
Thanks for any help anyone could provide.


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## dwaldman (May 3, 2016)

The below link from The New York School of Regional Anesthesia describes deep and superficial cervical plexus blocks as two separate methods that can be utilized. It seems you could report  CPT 64413 for the superficial technique that is in question. Below I also provided from the AMA CPT Network a description of 64413 describing "superficial" method.

http://www.nysora.com/techniques/ne...er-extremitya/3345-cervical-plexus-block.html

General Considerations

Cervical plexus block can be performed using two different methods. One is a deep cervical plexus block, which is essentially a paravertebral block of the C2-4 spinal nerves (roots) as they emerge from the foramina of their respective vertebrae. The other method is a superficial cervical plexus block, which is a subcutaneous blockade of the distinct nerves of the anterolateral neck. The most common clinical uses for this block are carotid endarterectomy and excision of cervical lymph nodes. The cervical plexus is anesthetized also when a large volume of local anesthetic is used for an interscalene brachial plexus block. This is because local anesthetic invariably escapes the interscalane groove and layers out underneath the deep cervical fascia where the branches of the cervical plexus are located.

The sensory distribution for the deep and superficial blocks is similar for neck surgery, so there is a trend toward favoring the superficial approach. This is because of the potentially greater risk for complications associated with the deep block, such as vertebral artery puncture, systemic toxicity, nerve root injury, and neuraxial spread of local anesthetic.

Distribution of Blockade

Cutaneous innervation of both the deep and the superficial cervical plexus blocks includes the skin of the anterolateral neck and the ante- and retroauricular areas (Figure 5). In addition, the deep cervical block anesthetizes three of the four strap muscles of the neck, geniohyoid, the prevertebral muscles, sternocleidomastoid, levator scapulae, the scalenes, trapezius, and the diaphragm (via blockade of the phrenic nerve).

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AMA CPT Network
Date: 09/06/2007 

Surgery 

Nrevous System 

Question 

Is it appropriate to report nerve block codes 64412, 64413, and 64418 more than one time per encounter if the injections are performed bilaterally? 

Answer 

The spinal accessory nerve and the suprascapular nerve are bilateral structures. Therefore, when bilateral injections are performed in either of these nerves, codes 64412, Injection, anesthetic agent; spinal accessory nerve, and 64418, Injection, anesthetic agent; suprascapular nerve, may be reported as appropriate, with modifier 50, Bilateral procedure, appended if performed bilaterally. Note, modifier 50 can also be used for bilateral superficial cervical plexus injections (reported with CPT code 64413). Some payers may expect bilateral or multiple units of the same injections to be filed in a manner other than using modifier 50. Some payers may also not recognize the procedure as eligible for additional payment when performed bilaterally. From a CPT coding perspective, reporting performance of these bilaterally is acceptable.


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