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Anesthesia Coding Alert

READER QUESTION ~ Look to 59 for Femoral, Popliteal Block Combo

Published on Wed Feb 21, 2007

Question: A new physician in our group sometimes administers a femoral nerve block and a popliteal block for postoperative pain management. How should I report this combination?

Massachusetts Subscriber

Answer: Physicians often use femoral nerve and popliteal fossa blocks for postoperative pain relief after lower-extremity procedures. The femoral nerve provides innervation to the front of the leg, while the nerve branches of the sciatic nerve provide innervation to the back of the leg below the knee.

Submit 64447 (Injection, anesthetic agent; femoral nerve, single) for the femoral block.

But CPT does not specify a code for a popliteal block because that describes an anatomic location (popliteal space or popliteal fossa) rather than a specific nerve (and most of CPT's nerve injection descriptors are based on specific nerves).

The popliteal fossa is a diamond-shaped space behind the knee. The sciatic nerve divides into two branches (the tibial nerve and the common peroneal nerve) above this triangular area. Check with your provider to verify whether he blocked these nerves with the injection. If so, report the popliteal injection with 64450 (... other peripheral nerve or branch).

Because your physician performs these injections in separate and distinct anatomic locations, you should report the blocks separately. If your physician also provides separate anesthesia services for the surgery, append modifier 59 (Distinct procedural service) to each injection code to indicate that the blocks are distinct from the anesthesia service.

If your physician does not perform the anesthesia service, simply report the injection codes. The National Correct Coding Initiative does not bundle 64447 with 64450, which means you would not need to append modifier 59 to either of the injection codes.

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