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CPT Code for Thoracic Paravertebral Block?

  1. Default CPT Code for Thoracic Paravertebral Block?
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    Does anyone know what CPT code would be used for a thoracic paravertebral block for postoperative pain in chest wall surgery? Several recommendations from the phsycians have been made; 64450 - Somatic nerve, other peripheral nerve or branch, 64520 - Autonomic Nerve, lumbar or thoracic (paravertebral sympathetic) or the intercostal nerve block of 64420 but these don't quite fit based on the description and intent of the codes.

    I am leaning towards the 64490 -64492 code series..Does anyone have any suggestons?

  2. #2
    Due to the fact "paravertebral block" is not any descriptor that comes to mind, if you provide the procedure note it might be easier to take a stab at your question.

  3. #3
    "Paravertebral" is included in the description for 64490-92, however this procedure is generally used for back pain, not "chest wall" pain. My providers will usually use 64420-21 for pain in the chest wall and ribs, but the descriptor does not include the word "paravertebral"...
    Walker Bachman, CPC, CPPM

  4. Default
    Left Thoracic Paravertebral Injection and Catheter Placement

    Patient transported to block room. Risk/benefits of procedure discussed. Patient wishes to proceed. Time out performed. T6 vertebra and left paravertebral space located under ultrasound guidance. Thoracic spine cleaned with chloraprep solution and draped in sterile fashion. 1 cc 2% lidocaine skin wheel. 18 g Tuohy needle advanced at T6 left paravertebral space. T6 transverse process encountered at 3 cm. Tuohy angled cephalad and advanced to 4 cm. Negative aspiration. 20 cc .25% lidocaine injected. Catheter placed in paravertebral space 10 cm at the skin. Catheter secured with mastisol, tegaderm, and transpore tape. No blood loss. No complications. Patient tolerated procedure well and was transported to floor with NC O2. 0.125% bupivicaine started @ 8 cc/hr.

  5. #5
    Sporter, sounds like the catheter was secured for potential infusion that would span more the one day or possibly was just one day. Regardless I am not aware of guidance that states the standard industry code for a thoracic paravertebral block, after reviewing the other responses and have try to determine what is being injected I agree with the other response that codes 64450 or 64420 come to up as potential nerves that could be targeted, but this also looks like it could fall under an unlisted procedure.

  6. #6
    Overland Park Kansas
    Default Anesthcoder
    I just heard back from our corporate coder regarding this issue. She consulted with another expert and they agreed that 64999-Unlisted nervous system procedure- is the only appropriate code for this post op block.

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