Anesthesia Coding Alert

Question: Our pain management specialist administered a single lumbar plexus block. How should I report this?

Arkansas Subscriber Answer: Pain management specialists often administer a lumbar plexus block (or a psoas compartment block) for pain control following hip, anterior thigh or knee surgery.

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), 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 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. Answers to You Be the Coder and Reader Questions were  reviewed by Darlene Ogbugadu, CPC, ACS-AN, billing supervisor for the department of anesthesiology for Northwestern Medical Faculty Foundation in Chicago.