Neurology & Pain Management Coding Alert

Reader Question:

'Unlisted' Is Your Only Choice for Continuous TAP Block

Question: Our physician used a TAP (Transverses Abdominis Plane) block for postoperative pain relief after anterior lumbar interbody fusion. I know that you would use 64450 when the physician doesn’t insert a catheter. Is 64449 the correct code to use for this block with a catheter?

Delaware Subscriber 

Answer: No, 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement]) is not your most accurate choice. If you’re reporting continuous infusion rather than a single shot with catheter, report 64999 (Unlisted procedure, nervous system) since CPT® does not include a specific code for continuous infusion for other peripheral nerves.  The CPT® Instructions for Use of CPT® Codebook directs providers, “Do not select a CPT® code that merely approximates the service provided.  If no such specific service exists, then report the service using the appropriate unlisted procedure or service code.”