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The procedure described by CPT® Code 64446 involves the administration of anesthetic agents and/or steroids to the sciatic nerve through a continuous infusion method using a catheter. This procedure is typically performed to alleviate pain associated with conditions affecting the lower extremities, particularly those involving the sciatic nerve. The process begins with the physician flexing the thigh at the hip to access the sciatic nerve effectively. A specific line is marked on the skin, extending from the back of the knee to a location between the greater trochanter and the ischial tuberosity, which serves as a guide for needle placement. Prior to the injection, the skin is cleansed and anesthetized to minimize discomfort during the procedure. The physician then introduces a needle just above the marked line to locate the sciatic nerve, verifying its position through electrical nerve stimulation, which elicits a motor response in the ankle, foot, or toes, or through the onset of sensory changes such as numbness or tingling. Imaging guidance may also be utilized to ensure accurate needle placement. Once the correct position is confirmed, the procedure transitions to the continuous infusion phase, where a catheter is placed to allow for ongoing delivery of the anesthetic agent and/or steroid. This method not only provides immediate pain relief but also allows for sustained management of pain through the continuous infusion of medication, enhancing the overall effectiveness of the treatment.
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The procedure described by CPT® Code 64446 is indicated for patients experiencing pain related to conditions affecting the sciatic nerve. The following are specific indications for performing this procedure:
The procedure for CPT® Code 64446 involves several critical steps to ensure effective placement of the catheter for continuous infusion of anesthetic agents and/or steroids. The following outlines the procedural steps:
After the completion of the procedure, the patient is monitored for any immediate adverse reactions or complications. It is essential to assess the effectiveness of the nerve block, which may include evaluating the patient's pain levels and any sensory or motor changes in the lower extremities. Patients may be advised on post-procedure care, including activity restrictions and signs of potential complications, such as infection or catheter displacement. Follow-up appointments may be scheduled to evaluate the long-term effectiveness of the continuous infusion and to make any necessary adjustments to the treatment plan.
| Short Descr | NJX AA&/STRD SC NRV NFS IMG | Medium Descr | INJECTION AA&/STRD SCIATIC NRV CONT NFS CATH IMG | Long Descr | Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 5 - Insertion of catheter or spinal stimulator and injection into spinal canal |
This is a primary code that can be used with these additional add-on codes.
| 77002 | CPT Add On MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | GC | This service has been performed in part by a resident under the direction of a teaching physician | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AG | Primary physician | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2023-01-01 | Changed | Code description changed. |
| 2020-01-01 | Changed | Code description changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Changed | Code description changed |
| 2008-01-01 | Changed | Code description changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |