The only thing that came to my mind is that the examples they give is post op pain block when performed when the patient is having general anesthesia. They don't give other examples.
AMA CPT AssistantOctober 2001 page 9
Coding Clarification:Anesthesia and Postoperative Pain Management
The following article builds on information originally presented in the February 1997 CPT Assistant article, "Anesthesia: Coding for Procedural Services."
Codes for procedures commonly used in the management of postoperative pain include 62318 and 62319 (both introduced in CPT 2000) for continuous epidural analgesia and the series of codes for somatic nerve blocks (64400-64450).
It is appropriate to report pain management procedures, including the insertion of an epidural catheter or the performance of a nerve block, for postoperative analgesia separately from the administration of a general anesthetic.
When general anesthesia is administered and these injections are performed to provide postoperative analgesia, they are separate and distinct services and are reported in addition to the anesthesia code. Whether the block procedure (insertion of catheter; injection of narcotic or local anesthetic agent) occurs preoperatively, postoperatively, or during the procedure is immaterial.
If, on the other hand, the block procedure is used primarily for the anesthesia itself, the service should be reported using the anesthesia code alone. In a combined epidural/general anesthetic, the block cannot be reported separately.
Examples
A patient having total knee replacement surgery may receive a regional anesthetic and a postoperative pain management agent through the same epidural catheter, in which case the only code reported would be 01402.
A femoral nerve block (64450) placed to provide post-operative analgesia for an anterior cruciate ligament repair or a total knee replacement would be reported separately from the surgical anesthesia.
A patient undergoing a thoracotomy might receive an epidural injection of a local anesthetic and/or narcotic (62318) for postoperative pain control in addition to the general anesthetic, which is administered through an endotracheal tube (00540). In this case, the epidural is not the surgical anesthetic and it would be reported separately, as an independent procedure.
Shoulder surgery could be performed under an interscalene brachial plexus block that would also provide postoperative analgesia. This would be reported using the anesthetic code (eg, 01620). If the block were intended primarily to alleviate postsurgical pain, and a general anesthetic was administered for the shoulder procedure, the block would be separately reportable using code 64415.
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64400-64530 (Nerve blocks)
CPT codes 64400-64530 (Nerve blocks) may be reported on the date of surgery if performed for postoperative pain management. Nerve block codes should not be reported separately on the same date of service as a surgical procedure if used as the primary anesthetic technique or as a supplement to the primary anesthetic technique. Modifier 59 may be utilized to indicate that a nerve block injection was performed for postoperative pain management, rather than intraoperative anesthesia, and a procedure note should be included in the medical record.
“if the anesthesia practitioner performed general anesthesia reported as CPT code 01382 and at the request of the operating physician inserted an epidural catheter for treatment of anticipated postoperative pain, the anesthesia practitioner may report CPT code 62319-59 indicating that this is a separate service from the anesthesia service. In this instance, the service is separately reportable whether the catheter is placed before, during, or after the surgery.
A brachial plexus block might also provide both the anesthesia and the postoperative pain control for an open reduction of a wrist fracture. Only the anesthesia code would be reported.