How To Use CPT Code 64446

CPT 64446 describes the continuous infusion of anesthetic agents and/or steroids into the sciatic nerve using a catheter, including catheter placement and imaging guidance. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64446?

CPT 64446 is used to describe the continuous infusion of anesthetic agents and/or steroids into the sciatic nerve using a catheter. This procedure involves placing a catheter near the sciatic nerve and administering the medication through the catheter over a period of time. It is typically performed to provide pain relief or manage inflammation in the leg.

2. Official Description

The official description of CPT code 64446 is: ‘Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure and administers anesthesia to ensure the patient is comfortable.
2. The provider locates the sciatic nerve, often using imaging guidance to assist in visualizing the nerve.
3. A catheter is inserted near the sciatic nerve, typically through a hollow insulated needle.
4. The provider confirms the correct placement of the catheter and removes the hollow needle.
5. The catheter is secured in place to prevent movement.
6. The provider may inject a local anesthetic through the catheter to provide immediate pain relief.
7. A continuous infusion of anesthetic agents and/or steroids is started through the catheter to provide ongoing pain relief or manage inflammation.
8. The provider monitors the patient’s response to the medication and adjusts the infusion rate as needed.
9. The catheter is removed once the desired effect has been achieved.

4. Qualifying circumstances

CPT 64446 is typically performed on patients who require continuous infusion of anesthetic agents and/or steroids to manage pain or inflammation in the leg. The procedure is often used for conditions such as sciatica, nerve entrapment, or postoperative pain. It is important to note that CPT 64446 should not be reported in conjunction with certain other codes, such as 01996, 76942, 77002, or 77003.

5. When to use CPT code 64446

CPT code 64446 should be used when a healthcare provider performs a continuous infusion of anesthetic agents and/or steroids into the sciatic nerve using a catheter. This code is appropriate when the procedure includes catheter placement and imaging guidance. It is important to review the documentation and ensure that all necessary components of the procedure are met before reporting CPT 64446.

6. Documentation requirements

To support a claim for CPT 64446, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for continuous infusion of anesthetic agents and/or steroids
• Details of the procedure, including catheter placement and imaging guidance
• Date and duration of the procedure
• Medications used for the infusion
• Monitoring of the patient’s response to the medication
• Any adjustments made to the infusion rate
• Removal of the catheter
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 64446, it is important to ensure that the procedure meets all the necessary criteria, including catheter placement and imaging guidance. It should not be reported in conjunction with certain other codes, as mentioned earlier. It is also important to follow any specific guidelines provided by the payer or insurance company. Proper documentation is crucial to support the claim and ensure accurate billing.

8. Historical information

CPT 64446 was added to the Current Procedural Terminology system on January 1, 2003. Since then, there have been several changes to the code, including updates to the description and the addition of notes to clarify its usage.

9. Examples

1. A patient with severe sciatica undergoes a continuous infusion of anesthetic agents and steroids into the sciatic nerve using a catheter to manage their pain.
2. Following a surgical procedure on the leg, a patient receives a continuous infusion of anesthetic agents and steroids into the sciatic nerve to manage postoperative pain.
3. A patient with nerve entrapment in the leg undergoes a continuous infusion of anesthetic agents and steroids into the sciatic nerve to alleviate their symptoms.
4. For a patient with chronic inflammation in the leg, a continuous infusion of anesthetic agents and steroids is administered into the sciatic nerve to manage the inflammation.
5. A patient with persistent leg pain receives a continuous infusion of anesthetic agents and steroids into the sciatic nerve to provide long-lasting pain relief.
6. Following a traumatic injury to the leg, a patient undergoes a continuous infusion of anesthetic agents and steroids into the sciatic nerve to manage their pain during the healing process.
7. A patient with a history of sciatic nerve pain receives a continuous infusion of anesthetic agents and steroids into the sciatic nerve to prevent flare-ups and manage their chronic condition.
8. For a patient with nerve damage in the leg, a continuous infusion of anesthetic agents and steroids is administered into the sciatic nerve to help alleviate their symptoms.
9. A patient with chronic inflammation in the leg undergoes a continuous infusion of anesthetic agents and steroids into the sciatic nerve to manage their condition and improve their quality of life.