Question: A pain management specialist in our ASC administered a single lumbar plexus block. How should I report this?
Arkansas Subscriber
Answer: Unlike many nerve block procedures with CPT codes for both a single injection and a continuous infusion by catheter, CPT does not include a code for a single injection to the lumbar plexus.
The closest code is 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration: APC 0207), but it’s not exactly what you need because it indicates continuous infusion. The relative value associated with 64449 includes all postoperative management services of the infusion.
Many providers choose to submit the single lumbar plexus block with 64449 and append modifier 52 (Reduced services).
Including a notation of "single injection to the right/left lumbar plexus for …" in Box 19 of the CMS-1500 form can assist with payer processing. Your provider’s documentation should clearly indicate that he administered a single injection rather than placed a continuous infusion catheter.
Learn more: For additional information on reporting services with modifier 52, see "Now’s the Time to Refresh Your ‘Reduced Services’ Coding," in Ambulatory Coding and Payment Report, Vol. 13, No. 1.
-- Reader Questions and You Be the Coder reviewed by Sarah L. Goodman, MBA, CPC-H, CCP, president of SLG Inc. in Raleigh, N.C.
