Orthopedic Coding Alert

Technique could improve post-op outcomes.

CPT^® has released its list of new, revised, and deleted codes for 2025. It contains new codes for a block your surgeon could be using during orthopedic procedures.

Check out these updates to CPT^® before the 2025 codes take effect on Jan. 1, 2025.

CPT^® Presents New Codes for This Block

In 2025, CPT^® has decided to devote a new set of codes to thoracic fascial pain blocks. This regional anesthesia is used to manage thoracic pain, particularly during thoracic and rib treatments. During the procedure, the surgeon injects local anesthetic into fascial planes in the chest area to block pain signals.

Benefit: These blocks can reduce the need for postoperative opioids and improve recovery by treating the patient’s pain in a more targeted manner.

The codes you’ll use for thoracic fascial plane block are:

• 64466 (Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed)
• 64467 (… by continuous infusion(s), including imaging guidance, when performed)
• 64468 (Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed)
• 64469 (… by continuous infusion(s), including imaging guidance, when performed)
• 64473 (Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed)
• 64474 (… by continuous infusion(s), including imaging guidance, when performed)

CPT^® has put some blanket restrictions on all of the codes listed above. When reporting any of these codes, you cannot report any of the following codes:

• 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation)
• +77001 (Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure))
• +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure))
• 77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation)
• 77021 (Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation)

Example Illustrates New Codes in Action

Check out this clinical scenario in which the surgeon might use the new fascial plane block codes:

The surgeon treats a 65-year-old patient at the hospital following a motor vehicle accident in which they were a passenger; they were in a car that collided with a sports utility vehicle. The patient reports significant pain in their left chest and trunk. They are also having breathing issues due to the pain. The surgeon orders a four-view chest X-ray, which confirms the presence of two left-sided fractures. During treatment, the surgeon performs a unilateral fascial plane block by continuous infusion.

The block involves placing the patient supine, and using ultrasound guidance to visualize the affected area. The surgeon inserts a block needle until the tip reaches the fascial plane, then injects 20 mL of 0.25% bupivacaine.

For this encounter, you would report:

• 64467 for the block
• 71048 (Radiologic examination, chest; 4 or more views) for the X-ray
• Modifier 26 (Professional component) appended to 71048 to show that you are only coding for your surgeon’s services during the X-ray, not the equipment used
• S22.42XA (Multiple fractures of ribs, left side, initial encounter for closed fracture)
• V43.61XA (Car passenger injured in collision with sport utility vehicle in traffic accident, initial encounter)

X-ray caveat: The above example features coding for the X-ray, but the surgeon might not be able to code for it. Whether or not the orthopedist is reimbursed for interpretation of the X-ray depends on facility protocol. They may have a contract with a radiologist or have a staff radiologist who is responsible for the official interpretation of X-rays.

Remember Codes Are Resequenced

The new codes are out of sequence, so you won’t find them in the proper numerical location in CPT^® 2025. They are additions to another group of resequenced codes, which start after +64484 (Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure)) and end before 64486 (Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)).

Between those codes, the 2025 CPT^® book will list these resequenced codes:

• # Denotes resequenced code
• Denotes new code
• #  64461 (Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed))
• #  +64462 (… second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure))
• #  64463 (… continuous infusion by catheter (includes imaging guidance, when performed))
•  64466
•  64467
•  64468
•  64469
•  64473
•  64474.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC