Orthopedic Coding Alert

Question: Do you know which CPT^® code we should use for a PENG block?

Ohio Subscriber

Answer: There are two scenarios in which a provider might use a PENG (pericapsular nerve group) block — and you code them differently.

Scenario 1: The provider administers a PENG block to the femoral and obturator nerve pericapsular branches to the hip joint (which is also known as FICB, or fascia iliaca compartment block). You should report 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch) for the local anesthetic injected between the iliopsoas muscle and the ileum. You can also include 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) for the ultrasound to help with needle placement.

Scenario 2: The provider administers a “3 in 1” block. This technique uses a different approach — directly at the femoral nerve — but also includes the lateral femoral cutaneous and obturator nerves. For this injection, report 64447 (Injection(s), anesthetic agent(s) and/or steroid; femoral nerve) with 76942.

This block will include coverage of the medial thigh (obturator), anterior thigh (femoral), and lateral thigh (lateral femoral cutaneous) nerve along with pericapsular branches.

Take note that the descriptors for both 64450 and 64447 encompass either single or multiple injections.

Only report 64450 or 64447 once per nerve plexus, nerve, or branch regardless of the number of injections administered along that nerve.

Background: The PENG block is a regional anesthetic technique developed for postoperative analgesia following total hip arthroplasty. This type of block might also be used to help manage post-traumatic pain associated with fractures of the proximal femur/femoral head. It is thought to provide more complete analgesia to the hip because of where it deposits the local anesthetic.