CPT for lumbar plexus single shot

[seinfeld]

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Our billing company is currently using a nondescript code of 64450 which i found out bills only 5 units while a sciatic bills 7 with 64445. seems odd considering the LPB is a more advnaced technique.

Anyone have another CPT they use?

 

[periopdoc]

Hmm I spoke to quickly so I am deleting this. The BBraun guide lists a CPT code for the lumbar plexus block that is actually for a transforaminal injection.

Now back to OR 12 to finish the LVAD

- pod

 

[periopdoc]

Ok so the B. Braun Site has some really excellent information on billing for regional anesthesia. Unfortunately, they list two different codes for a single shot lumbar plexus block, neither of which is correct. In different areas they list 62319 (epidural injection) paying 9 units and 64483 (transforaminal epidural) paying 8 units, but both of these codes are for neuraxial procedures.

I found two newsletters from coding companies that discuss the problem of billing for single shot lumbar plexus blocks given that there is no CPT code for this procedure. Both of them recommend billing 64449-52. This is a continuous lumbar plexus block with a 52, reduced fee, modifier. They recommend including an explanation that the reduced fee is because a catheter was not placed.

Don't forget your modifier 59 to remind the payer that this is a separate pain control procedure from your primary anesthetic.

Here are the links to the newsletters

Coding Institute

Many lumbar plexus blocks are continuous infusion, which you should report with 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement]... But when the lumbar plexus block is not administered by continuous infusion, the coding gets trickier. CPT does not include a code for a lumbar plexus injection. Your best option is to still report 64449, but append modifier 52 (Reduced services) since it is a single injection instead of continuous infusion. Include documentation that explains the situation.

Anesthesia Marketing

When a single lumbar plexus block—also referred to as a psoas compartment block—is administered for chronic pain, how should it be coded? ... CPT does not have a dedicated code for a lumbar plexus injection. The closest code is 64449... It’s not exactly right, however, because it indicates continuous infusion... One option is to submit the single lumbar plexus block with 64449 and append modifier 52 (reduced services), being sure to document that a single injection was administered in this case rather than the placement of a continuous infusion catheter.

Caveats newsletter one was published in 2005 and newsletter two was published in 2007. Neither reflect any interim changes including the 2009 modification of the continuous block 644** codes that removed the 10-day followup period.

I am not sure how reduced the reimbursement would be with this strategy. Anyone know?

If you don't want to go to all the trouble of that, then I would code it as a 64447 femoral nerve block since you are blocking the femoral nerve as a component of this block and I believe it pays 2 more units than the 64450 "other peripheral nerve branch" code. That used to be the case, but I don't yet have a 2009 RVG to verify that this continues to be the case.


- pod

 

[seinfeld]

Ok so the B. Braun Site has some really excellent information on billing for regional anesthesia. Unfortunately, they list two different codes for a single shot lumbar plexus block, neither of which is correct. In different areas they list 62319 (epidural injection) paying 9 units and 64483 (transforaminal epidural) paying 8 units, but both of these codes are for neuraxial procedures.

I found two newsletters from coding companies that discuss the problem of billing for single shot lumbar plexus blocks given that there is no CPT code for this procedure. Both of them recommend billing 64449-52. This is a continuous lumbar plexus block with a 52, reduced fee, modifier. They recommend including an explanation that the reduced fee is because a catheter was not placed.

Don't forget your modifier 59 to remind the payer that this is a separate pain control procedure from your primary anesthetic.

Here are the links to the newsletters

Coding Institute



Anesthesia Marketing



Caveats newsletter one was published in 2005 and newsletter two was published in 2007. Neither reflect any interim changes including the 2009 modification of the continuous block 644** codes that removed the 10-day followup period.

I am not sure how reduced the reimbursement would be with this strategy. Anyone know?

If you don't want to go to all the trouble of that, then I would code it as a 64447 femoral nerve block since you are blocking the femoral nerve as a component of this block and I believe it pays 2 more units than the 64450 "other peripheral nerve branch" code. That used to be the case, but I don't yet have a 2009 RVG to verify that this continues to be the case.


- pod

Thanks for your help