Pain Management Coding Alert
Understand the Lumbar Sympathetic/Chain Block Difference
Question: I have charts from one of our physicians for two different patients on the same day. In one, he documented administering a lumbar sympathetic chain block and the other a lumbar sympathetic block. What’s the difference, and how do I code them?
Indiana Subscriber
Answer: Anatomically, the sympathetic nerves are a chain of nerves that run on the front side of the spinal vertebrae. Providers typically inject about 10cc per level injected, which is a much larger volume of medication than with epidural steroid injections (ESI) or facet injections. The increased volume allows the medication to spread up and down the sympathetic chain, producing an improved sympathetic block.
The terminology your physician used here is similar to the old saying “You say tomato, I say to-mah-to.” Whether he calls it a lumbar sympathetic block or a lumbar sympathetic chain block, he still performs the same procedure. Report the service with 64520 (Injection, anesthetic agent; lumbar or thoracic [paravertebral sympathetic]).
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