Anesthesia Coding Alert

Question: How do you code an adductor canal block continuous catheter for post-op pain management after total knee replacement?

Washington Subscriber 

Answer: The term “adductor canal” could refer to “femoral,” which would point you to code 64448 (Injection, anesthetic agent; femoral nerve, continuous infusion by catheter [including catheter placement]) for a continuous block, or 64447 (Injection, anesthetic agent; femoral nerve, single) for a single injection. If you submit 64447, some coders recommend referencing the “selective femoral” nerve block technique (a more proximal approach to the saphenous nerve block) if the payer requests justification. 

But because CPT® does not include a specific code for this type of block or catheter placement, another option is 64450 (Other peripheral nerve block). If you report 64450 for post-op pain management, append modifier 59 (Distinct procedural service).  

Tip: Don’t include 01996 (Daily pain management through continuous drug administration) on the same claim as 64487 or 64448, because the service covered by those procedure codes includes continuous drug delivery during the post–op period.

Physicians administer femoral nerve injections in conjunction with surgery of the anterior thigh, quadriceps tendon, and knee area. The patient remains awake, but the entire anterior thigh and most of the femur and knee joint become anesthetized.