How To Use CPT Code 64449

CPT 64449 describes the administration of an anesthetic agent, steroid, or both through continuous infusion using a catheter to block the lumbar plexus. 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 64449?

CPT 64449 is used to describe the continuous infusion of an anesthetic agent, steroid, or both through a catheter to block the lumbar plexus. This procedure is performed to keep the target region anesthetized for as long as necessary. The lumbar plexus is a network of nerves in the lumbar region that supplies the skin and muscles of the lower extremity. The placement of the catheter is included in this code and should not be reported separately.

2. Official Description

The official description of CPT code 64449 is: ‘Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement).’

3. Procedure

1. The provider administers a local anesthetic agent and/or steroid through continuous infusion using a catheter.
2. The catheter is placed near the lumbar plexus through a posterior approach.
3. The provider confirms the needle location using a nerve stimulator or ultrasound.
4. A test dose of the anesthetic agent is administered, followed by the insertion of the infusion catheter through the needle.
5. The catheter is advanced into the lumbar plexus and the iliopsoas compartment.
6. The needle is removed, leaving the catheter in place.
7. The provider observes the patient for appropriate anesthetic spread and secures the catheter.
8. A continuous infusion pump is attached to the catheter to administer the anesthetic agent and/or steroid.

4. Qualifying circumstances

CPT 64449 is performed for major lower limb surgery and postoperative pain management following hip, anterior thigh, or knee surgery. It is especially useful for pain control after a total knee or hip replacement and helps facilitate rehabilitation. The procedure is typically performed by a provider who administers anesthetic agents and is familiar with the lumbar plexus block technique.

5. When to use CPT code 64449

CPT code 64449 should be used when a continuous infusion of an anesthetic agent, steroid, or both through a catheter is performed to block the lumbar plexus. It is important to note that this code should not be reported in conjunction with code 01996. Before filing a claim for CPT 64449, it is advisable to check with the payer to ensure reimbursement guidelines for continuous infusion are met.

6. Documentation requirements

To support a claim for CPT 64449, the provider must document the following information:

• Reason for the procedure and the need for continuous infusion
• Details of the catheter placement and confirmation of needle location
• Type and dosage of the anesthetic agent and/or steroid used
• Observations of appropriate anesthetic spread and analgesia
• Confirmation of catheter functionality and attachment of the continuous infusion pump
• Any additional relevant information or observations

7. Billing guidelines

When billing for CPT 64449, ensure that the continuous infusion is performed through a catheter for the lumbar plexus block. It is important to note that code 64449 should not be reported in conjunction with code 01996. Additionally, ultrasound guidance should be separately reported if used during the procedure. It is recommended to check with the payer for specific reimbursement guidelines regarding continuous infusion services.

8. Historical information

CPT 64449 was added to the Current Procedural Terminology system on January 1, 2004. Since its addition, there have been two code changes. On January 1, 2009, the code description was updated to include daily management for anesthetic agent administration. The most recent code change occurred on January 1, 2020, with a revised code description.

9. Examples

1. A patient undergoes major lower limb surgery and requires postoperative pain management. The provider administers a continuous infusion of an anesthetic agent through a catheter to block the lumbar plexus, providing effective analgesia.
2. Following a total hip replacement, a patient experiences significant pain. The provider performs a lumbar plexus block using continuous infusion to manage the postoperative pain and facilitate the patient’s rehabilitation process.
3. A patient undergoes anterior thigh surgery and requires pain control. The provider administers a continuous infusion of an anesthetic agent and steroid through a catheter to block the lumbar plexus, ensuring optimal analgesia.
4. After a knee surgery, a patient experiences severe pain. The provider performs a lumbar plexus block using continuous infusion to provide effective pain management and improve the patient’s overall comfort.
5. A patient undergoes a hip replacement and requires postoperative pain control. The provider administers a continuous infusion of an anesthetic agent and steroid through a catheter to block the lumbar plexus, ensuring adequate analgesia and facilitating the patient’s recovery.