Anesthesia Coding Alert

Question: How should I code a therapeutic nerve block of the femoral nerve when our pain management specialist uses a catheter for continuous infusion for
the block?
Texas Subscriber

Answer: Use 64448 (Injection, anesthetic agent; femoral nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) for this procedure.

Your specialist might perform nerve blocks for either diagnostic or therapeutic purposes, but the reason for the block does not affect how you code. Pay attention to how the physician administers the nerve block (such as continuous infusion or single injection) to determine the correct code.

CPT lists each of the continuous infusion nerve block codes within the anesthetic agent injection, somatic nerve category, immediately following the code that describes a single injection block of the same nerve.

Example: CPT lists 64448 directly beneath 64447     (. . . femoral nerve, single).

Bonus tip: A continuous nerve infusion by catheter means you have a 10-day global fee (with the exception of an epidural continuous infusion).
The CPT code description clearly states "...including daily management for anesthetic administration." This is not true with a single injection, which is why for 2008, 64447 carries 1.89 relative value units (RVUs), while 64448 is valued at 4.41.