© Copyright 2025 American Medical Association. All rights reserved.
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, where they interact with intercostal nerves that extend medially into the epidural spaces. The administration of a thoracic PVB effectively blocks both somatic and sympathetic nerves on the same side (ipsilateral) while maintaining minimal impact on cardiovascular and respiratory functions. During the procedure, the patient is typically positioned in a supported sitting posture or resting in a lateral decubitus position, with the side intended for the block positioned uppermost. The clinician marks the spinous processes on the patient's skin and measures a parasagittal line, which 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. For more complex cases, CPT® Code 64463 is utilized to report the continuous infusion of anesthetic through an indwelling catheter, which is threaded into the paravertebral space after the spinal needle is removed. This method allows for a sustained delivery of anesthetic, enhancing pain management during the postoperative period.
© Copyright 2025 Coding Ahead. All rights reserved.
The thoracic paravertebral block (PVB) is indicated for various clinical scenarios, particularly in the context of surgical and trauma-related procedures. The following conditions and situations warrant the use of this anesthetic technique:
The procedure for performing a thoracic paravertebral block involves several critical steps to ensure effective anesthesia delivery. The following outlines the procedural steps:
After the thoracic paravertebral block procedure, patients are monitored for any immediate complications or side effects associated with the anesthesia. Expected recovery includes a gradual return to normal sensation and motor function in the affected area. Continuous infusion of anesthetic through the indwelling catheter is maintained to ensure effective pain management. Clinicians should provide instructions regarding the care of the catheter site, signs of infection, and when to seek medical attention. Follow-up assessments may be necessary to evaluate the effectiveness of the block and to make any adjustments to the pain management plan as needed.
| Short Descr | PVB THORACIC CONT INFUSION | Medium Descr | PVB THORACIC CONT CATHETER INFUSION W/IMG GID | Long Descr | Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes 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) | P6B - Minor procedures - musculoskeletal | MUE | 1 |
| 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. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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). | RT | Right side (used to identify procedures performed on the right side of the body) | 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 | 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
|
|---|---|---|
| 2017-01-01 | Changed | Guidelines changed. |
| 2016-01-01 | Added | Added |
Get instant expert-level medical coding assistance.