How To Use CPT Code 64520

CPT 64520 is a code for the injection of anesthetic agents into the lumbar or thoracic paravertebral sympathetic nerves, used to treat painful conditions and as an analgesic for various procedures. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64520.

1. What is CPT 64520?

CPT 64520 is a medical billing code used to describe a specific type of nerve block procedure, where an anesthetic agent is injected into the lumbar or thoracic paravertebral sympathetic nerves. This procedure is commonly used to treat painful conditions in the thorax, abdomen, and lower extremities, as well as to provide analgesia for various thoracic and abdominal procedures.

2. 64520 CPT code description

The official description of CPT code 64520 is: “Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic).”

3. Procedure

The 64520 procedure involves the following steps:

1. The patient is appropriately prepped and draped.
2. Using fluoroscopic guidance, the provider directs the needle carefully through the skin and tissue into the exact location of the sympathetic nerve.
3. Verification of needle placement is performed, including careful aspiration to ensure the needle is not within a vessel (intravascular) or under a membrane of the spinal cord (intrathecal).
4. The provider slowly injects a local anesthetic into the lumbar or thoracic paravertebral sympathetic nerves.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 64520 services are those experiencing painful conditions in the thorax, abdomen, or lower extremities, or those requiring analgesia for thoracic or abdominal procedures. The provider must determine that a nerve block is the most appropriate treatment option for the patient’s condition, and the patient must provide informed consent for the procedure.

5. When to use CPT code 64520

It is appropriate to bill the 64520 CPT code when the provider performs a nerve block on the lumbar or thoracic paravertebral sympathetic nerves to treat painful conditions or provide analgesia for thoracic or abdominal procedures. The provider must ensure that the procedure is medically necessary and that all documentation requirements are met.

6. Documentation requirements

To support a claim for CPT 64520, the following information must be documented:

• Patient’s medical history and physical examination findings
• Diagnosis and indication for the procedure
• Details of the procedure, including the type and amount of anesthetic agent used
• Verification of needle placement and any complications encountered during the procedure
• Patient’s response to the procedure and any post-procedure care provided

7. Billing guidelines

When billing for CPT code 64520, it is essential to follow the appropriate billing guidelines and rules. These may include:

• Ensuring that the procedure is medically necessary and supported by documentation
• Using the correct modifiers, if applicable, to indicate bilateral procedures or other specific circumstances
• Verifying payer-specific requirements and policies for billing CPT 64520
• Submitting claims in a timely manner and following up on any denied or rejected claims

8. Historical information

CPT 64520 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 64520

Five similar codes to CPT 64520 and how they differ are:

• CPT 64490: Injection of anesthetic agent into the cervical paravertebral facet joint
• CPT 64493: Injection of anesthetic agent into the lumbar or sacral paravertebral facet joint
• CPT 64450: Injection of anesthetic agent into peripheral nerves of the lower extremity
• CPT 64479: Injection of anesthetic agent into the cervical or thoracic epidural space
• CPT 64483: Injection of anesthetic agent into the lumbar or sacral epidural space

10. Examples

Here are 10 detailed examples of CPT code 64520 procedures:

1. A patient with chronic abdominal pain undergoes a lumbar paravertebral sympathetic nerve block to alleviate pain.
2. A patient with complex regional pain syndrome in the lower extremity receives a thoracic paravertebral sympathetic nerve block for pain management.
3. A patient undergoing a thoracic surgical procedure receives a thoracic paravertebral sympathetic nerve block for intraoperative analgesia.
4. A patient with postherpetic neuralgia in the thoracic region undergoes a thoracic paravertebral sympathetic nerve block for pain relief.
5. A patient with refractory angina receives a thoracic paravertebral sympathetic nerve block to reduce chest pain.
6. A patient with chronic pancreatitis undergoes a lumbar paravertebral sympathetic nerve block for pain management.
7. A patient with peripheral vascular disease and ischemic pain in the lower extremity receives a lumbar paravertebral sympathetic nerve block for pain relief.
8. A patient undergoing a laparoscopic abdominal procedure receives a lumbar paravertebral sympathetic nerve block for postoperative analgesia.
9. A patient with intercostal neuralgia undergoes a thoracic paravertebral sympathetic nerve block for pain management.
10. A patient with chronic pelvic pain receives a lumbar paravertebral sympathetic nerve block to alleviate pain.