Anesthesia Coding Alert

Question: Our anesthesiologist administered a single-shot lumbar plexus block for postoperative pain management. How should I report this? 


Kansas Subscriber
Answer: You should typically report lumbar plexus blocks with 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration). This code doesn't exactly fit your situation because the physician administered a single injection.

Coders have varying opinions on what you should report for a single-shot lumbar plexus block. Some recommend 64449 with modifier 52 (Reduced services), while others opt for 64450 (- other peripheral nerve or branch) with modifier 59 (Distinct procedural service). Advocates of 64450-59 say this code is more accurate because the lumbar plexus block is separate from the procedural anesthesia.

Check your carrier's guidelines before submitting the claim. Either way, include an explanation of the procedure to indicate that it was a single shot for post-op pain management, and include a diagnosis such as V58.49 (Other specified aftercare following surgery) to support the need for post-op pain management. You Be the Coder and Reader Questions were answered by Terry Celestino, CPC, of Tejas Anesthesia in San Antonio.