New for 2016: Three codes were added pertaining to the nervous system for paravertebral nerve blocks when performed in the thoracic area for post-op pain management.
Paravertebral block (PVB) (paraspinous block) thoracic; single injection site (includes imaging guidance, when performed)
second and any additional injection site(s) (includes imaging guidance, when performed)(list separately in addition to code for primary procedure)
continuous infusion by catheter (includes imaging guidance, when performed)
Per the 2016 CPT Changes: An Insider’s View, “Paravertebral blocks (also known as paraspinous blocks) and continuous infusion can be used for the benefit of pain management for patients undergoing thoracic, breast, and upper abdominal surgery. The intent is to provide a dense, ipsilateral somatic and sympathetic blockade as an analgesic alternative to a neuraxial blockade (which is performed as an epidural or via access to the spine). Paravertebral blocks target the sympathetic chain of nerves and multiple intercostals nerves and spinal nerves and their branches, and may be utilized for dermatomal coverage from T2-L1”.¹
For the performance of a single injection, CPT code 64461 is to be reported.
When additional injections are performed, CPT add-on code + 64462 should be reported. Per CPT parenthetical, 64462 cannot be reported more than one time per day.
To report the performance of a catheter placement for continuous infusion, CPT code 64463 is to be reported. These services are unilateral services, if performed bilaterally modifier 50, or RT / LT would be applicable per payer guidelines.
Note: the use of imaging guidance, both ultrasound CPT 76942 and Fluoroscopy 77002 and 77003 are included and not reported separately.
Documentation should support time of placement, performing provider and the procedure details itself. Additionally, these new codes may be reported as long as they are not the mode of anesthesia for the case, and meet the criteria for separate reporting (i.e., for postoperative pain management at the request of the surgeon). Refer to the National Correct Coding Initiative (NCCI) Policy Manual, Chapter 2 – Anesthesia Services, for additional guidance.