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A thoracic paravertebral block (PVB), also known as a paraspinous block, is a medical procedure designed to provide unilateral anesthesia, primarily for patients undergoing thoracic or breast surgeries, as well as those suffering from chest trauma or rib fractures. The paravertebral space is anatomically defined as a wedge-shaped compartment located adjacent to the vertebral bodies, which allows for communication superiorly and inferiorly across the ribs. Within this space, spinal nerves emerge from the intervertebral foramina and branch laterally into the paravertebral space, while intercostal nerves extend medially into the epidural spaces. The administration of a thoracic PVB effectively blocks both somatic and sympathetic nerves on the ipsilateral side, which is the same side as the procedure, while minimizing potential cardiovascular or respiratory complications. During the procedure, the patient is typically positioned in a supported sitting posture or in a lateral decubitus position with the side to be blocked elevated. The clinician marks the spinous processes on the patient's skin and measures a parasagittal line that is drawn laterally to the midline. Local anesthetic is then infiltrated into the subcutaneous tissue and paravertebral muscles along this line. Utilizing both visual and tactile landmarking techniques, along with ultrasound imaging when necessary, a spinal needle attached to a syringe containing local anesthetic is carefully inserted into the paravertebral space, where the anesthetic is subsequently injected. This procedure is crucial for pain management in various thoracic conditions and surgical interventions, providing significant relief and enhancing patient comfort during recovery.
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After the thoracic paravertebral block is performed, patients are typically monitored for any immediate adverse reactions or complications. It is important to assess the effectiveness of the block in providing pain relief. Patients may experience temporary numbness or weakness in the affected area, which is expected. Recovery time can vary, but patients are generally advised to rest and avoid strenuous activities for a short period following the procedure. Additionally, clinicians may provide specific post-procedure care instructions, including pain management strategies and signs of potential complications that should prompt further medical evaluation.
| Short Descr | PVB THORACIC 2ND+ INJ SITE | Medium Descr | PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID | Long Descr | Paravertebral block (PVB) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6B - Minor procedures - musculoskeletal | MUE | 1 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 64461 | Resequenced Code MPFS Status: Active Code APC T ASC G2 Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed) |
| 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | RT | Right side (used to identify procedures performed on the right side of the body) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | LT | Left side (used to identify procedures performed on the left side of the body) | GA | Waiver of liability statement issued as required by payer policy, individual case | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | 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 | 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. | 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.) | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | P3 | A patient with severe systemic disease | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 |
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| 2016-01-01 | Added | Added |
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