Anesthesia Coding Alert

Question: How should I code a continuous paravertebral block?

Answer: "Paravertebral block" is a fairly generic term, which reflects that the provider performs an injection or block alongside or near the vertebrae. Many codes represent injections to anatomic structures found "alongside" the vertebrae, including trigger point injections (20552-20553), tendon and ligament injections (20550-20551), and more. Physicians do not commonly perform most of these blocks/injections as a continuous infusion with a catheter.

Study the options: CPT includes several continuous infusion codes for various anatomic sites (the sciatic nerve, femoral nerve, brachial plexus, etc.), but none of these really fit the description of "paravertebral." Some providers place a continuous infusion catheter in the thoracic paravertebral region for acute post-thoracotomy or mastectomy pain, which blocks the intercostals nerve. Unfortunately, CPT doesn't include a code for such a continuous infusion unless the provider places the catheter in the epidural space.

Another consideration: Your physician might have inserted a lumbar plexus continuous infusion to treat lower-extremity postoperative pain. The lumbar plexus runs through the psoas muscle compartment in the lower back, so some providers may consider this procedure to be a paravertebral continuous infusion, which you should report as 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration).

Coding caveat: As with any procedure, follow CPT's instruction: "Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code."

Check with your physician to confirm whether 64449 best applies to the procedure. If not, you might need to report 64999 (Unlisted procedure, nervous system) with supporting documentation instead.