© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 64449 involves the administration of anesthetic agents and/or steroids into the lumbar plexus through a continuous infusion method. This procedure is typically performed to provide pain relief in the lower body, particularly for conditions affecting the hip and leg. The lumbar plexus is a network of nerves located in the lower back that supplies sensation and motor function to the lower limbs. The posterior approach refers to the technique used to access the lumbar plexus from the back. During the procedure, a catheter is placed to allow for the continuous delivery of the medication, ensuring prolonged analgesic effects. The process begins with the identification of the appropriate injection site, which is usually located between the iliac crests, followed by the cleansing and preparation of the skin. A local anesthetic may be administered to minimize discomfort during the procedure. A specialized needle, often connected to a peripheral nerve stimulator, is then carefully advanced into the psoas compartment, where the lumbar plexus is located. The correct placement of the needle is confirmed through nerve stimulation, which elicits specific muscle contractions. Following this, aspiration is performed to check for the presence of blood or cerebrospinal fluid, ensuring that the needle is not in a blood vessel or the spinal canal. A test dose of the anesthetic is administered to further confirm proper placement. Once the initial injection is completed, a catheter is inserted to facilitate continuous infusion of the anesthetic agent and/or steroid, providing ongoing pain relief. The effectiveness of the block is assessed by evaluating the analgesia in the left leg and hip, and the catheter's position is verified to prevent complications associated with incorrect placement.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 64449 is indicated for various conditions that require pain management in the lower body. The following are specific indications for performing this procedure:
The procedure for CPT® Code 64449 involves several critical steps to ensure effective administration of the anesthetic agent and/or steroid. The following outlines the procedural steps:
After the completion of the procedure, patients are typically monitored for any immediate adverse reactions to the anesthetic agent and/or steroid. It is essential to assess the effectiveness of the block by evaluating the level of analgesia in the affected leg and hip. Patients may be advised on post-procedure care, which can include instructions on activity levels, signs of complications to watch for, and follow-up appointments to evaluate the ongoing effectiveness of the pain management strategy. Additionally, healthcare providers may discuss the potential need for adjustments in the infusion rate or medication based on the patient's response to treatment.
| Short Descr | NJX AA&/STRD LMBR PLEX NFS | Medium Descr | INJECTION AA&/STRD LUMBAR PLEXUS CONT NFS CATH | Long Descr | Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) | 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.
| 77003 | CPT Add On MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) |
| LT | Left side (used to identify procedures performed on the left side of the body) | 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. | 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 | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | AG | Primary physician | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | KX | Requirements specified in the medical policy have been met | P3 | A patient with severe systemic disease | QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | QX | Crna service: with medical direction by a physician | 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 | 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 | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2020-01-01 | Changed | Code description changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Changed | Code description changed |
| 2004-01-01 | Added | First appearance in code book in 2004. |