Anesthesia Coding Alert

Question: Which code represents a single lumbar plexus block administered for postoperative pain? I considered new code 64449 but don't know if it's appropriate.

Connecticut Subscriber

Answer: You have several options in this case, provided the block is a distinct and separate procedure from the surgical anesthesia.

The first option is 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) with modifier -52 (Reduced services). Append modifier -52 (and reduce your fee) because, although the injection procedure is the same, the provider does not thread a catheter or provide any postprocedure daily management.

Another option is 64483 (Injection, anesthetic and/or steroid, transforaminal epidural; lumbar or sacral, single level). Although this code does not specify "plexus," it might be your closest option because there is no code for a single injection to the lumbar plexus.

A final option is 64999 (Unlisted procedure, nervous system). If you report this code, you should also submit documentation and a letter explaining the specific procedure. Because one challenge in reporting unlisted-procedure codes is not having set base units, consider 64520 (Injection, anesthetic agent; lumbar or thoracic [paravertebral sympathetic]) as a close approximation for fees and base units (64520 is eight units).

-- You Be the Coder and Reader Questions were answered by Marvel J. Hammer, RN, CPC, CHCO, owner of MJ Consulting in Denver.