Neurosurgery Coding Alert
Use Unlisted Code When Others Don’t Describe Procedure
Question: I’ve reported CPT® code 64999 for an erector spinae pain (ESP) block for years, but my current employer wants me to use 64461. Which is correct? Washington Subscriber Answer: You are correct that CPT® code 64999 (Unlisted procedure, nervous system) is more appropriate for this procedure instead of 64461 (Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)). Here’s why: Erector spinae plane (ESP) blocks involve injecting anesthetic into the musculofascial plane between the paraspinal back muscles and underlying thoracic vertebrae. The erector spinae is a group of muscles and tendons extending the length of the spine (and on both sides). This more recently developed block is superficial to the transverse processes, and is therefore associated with a lesser risk of pneumothorax or intrathecal injection when compared with paravertebral block (PVB). In contrast, a PVB is a comparatively deeper injection and targets the sympathetic chain of nerves and somatic nerves (intercostal and spinal nerves and their branches) anywhere from T2 to L1. Since the target of the injection as well as the risk is different between ESP block and PVB, one should not report an ESP block with 64461.
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Use Unlisted Code When Others Don’t Describe Procedure
Question: I’ve reported CPT® code 64999 for an erector spinae pain (ESP) block for years, [...]
