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 -- also known as 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 doesn't include a code for a single injection to the lumbar plexus.

There is a code for an anesthetic injection in the lumbar plexus (64449, Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration), but this isn't an exact match for the procedure because it indicates continuous infusion by catheter.-

Some payers may allow you to submit the single lumbar plexus block with 64449 and append modifier 52 (Reduced services). Modifier 52 reflects that the procedure performed was reduced because 64449 includes all postoperative management services of the infusion.

Be careful: The CPT Instructions for Use of the CPT Codebook state, "Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted procedure or service code." Reporting the single lumbar plexus injection with 64999 (Unlisted procedure, nervous system) may be the more accurate choice per CPT.

Tip: 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 of whichever coding option your payer requests.

Remember: Your provider's documentation should clearly indicate that the specialist administered a single injection rather than placed a continuous infusion catheter.