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Wiki Epidural for sympathetic continuous block

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kimberly becker

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Looking for ideas if anyone knows which code to use. Pt. has RSD of the leg. Dictation notes say that the epidural needle was introduced at the L4-L5 level. 64520 does not say continuous, and I have ruled out 64449 because distaction does not specify lumbar plexus.
 
Kimberly:
Without seeing the OP note, I cannot give you too much detail. I do, however know that the CPT code for indewelling catheter placement for intrathecal or epidural drug infusion with sub-q reservior codes out to 62319 and 62360. Like I said, I would have to see the OP report to really guide you in the right direction for this.
 
Op report continuous block

Thanks for your response Amy. I hope you have an idea what I can use for a continuous code.

Plan: Proceed with a sympathetic block using an epidural with Ropivacaine and Fentanyl and a continuous infusion for 12 hours. Pt. will have an I.V. placed, epidural placed and Foley catheter and continuous monitoring during epidural infusion.

Procedure: Epidural with Ropivacaine and Fentanyl infusion for sympathetic block at the level of L4-L5 with catheter placemnet and continuous infusion.

Pt. had an inravenous line started in left arm. A local anesthetic was given at the level of L4-L5 midline. Epidural needle was introduced at the level L4-L5 midline. Needle advanced into the epidural space. Epidural catheter was advanced to 4 cm. Catheter was taped in place. Infusion of Ropivacaine w/Fentanyl was started, epidurally. Infusion started at rate of 12mg. per hour basal rate and 3 mg. PCA dose every 15 minutes. Pt. will have continuous monitoring.
 
I would caution you against using 62319 here. The CPT guidelines at the beginning of this section state:

"The placement and use of a catheter to administer one or more epidural or subarachnoid injections on a single calendar day should be reported in the same manner as if a needle had been used, ie, as a single injection using either 62310 or 62311. Such injections should not be reported with 62318 or 62319. Threading a catheter into the epidural space, injecting substances at one or more levels and then removing the catheter should be treated as a single injection (62310, 62311). If the catheter is left in place to deliver a substance(s) over a prolonged period (ie, more than a single calendar day) either coninuously or via intermittent bolus, use 62318, 62319 as appropriate."

Since your note states clearly that the infusion was less than a calendar day, I don't think 62319 would be appropriate.
 
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