Anesthesia Coding Alert

Question: CPT Codes does not have a code for continuous infusion to the popliteal nerve. What code should I report when our physician places a continuous infusion catheter in this area for postoperative pain relief?

Wisconsin Subscriber

Answer: Some providers recommend 64446 (Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter [including catheter placement], including daily management for anesthetic agent administration). Other providers believe this is not the best option because the popliteal nerve is not the same as the sciatic and is two levels away from the sciatic nerve (the sciatic nerve branches to the tibial, which branches to the popliteal). They say 64450 (... other peripheral nerve or branch) is a more accurate choice.

Remember that 64450 represents a single block, and the physician actually places a continuous infusion catheter during this procedure. Because of this, append modifier -22 (Unusual procedural services) to 64450 and submit a letter noting the additional work involved in the case. Even if you don't report 64446 for the procedure, some coders recommend basing your reimbursement amount on this 12-unit code.