Neurology & Pain Management Coding Alert

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

Answer: CPT doesn't include a code for a single injection to the lumbar plexus, but that doesn't mean you're out of luck. The closest option 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). Code 64449 isn't an exact match for the procedure, however, because it indicates continuous infusion by catheter.

Option 1: 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.

Option 2: Your payer might not accept 64449-52 for the single lumbar plexus block. As CPT instructions 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." Because of this guideline, a payer might require you to report a single lumbar plexus injection with 64999 (Unlisted procedure, nervous system) and supporting notes.

Tip: Your provider's documentation should clearly indicate that the specialist administered a single injection rather than placed a continuous infusion catheter. Including a notation of "single injection to the right/left lumbar plexus for ..." in the claim form can assist with payer processing of whichever coding option your payer requests.

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.