CPT® Code 64466

Official Description

Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed

Common Language Description

A thoracic fascial plane block is a medical procedure designed to alleviate post-operative pain, particularly following chest surgery, while also aiming to reduce the reliance on opioid medications for pain management. This procedure involves the precise injection of a local anesthetic into the thoracic fascial plane, which is a specific anatomical space within the chest wall. The use of continuous ultrasound guidance is a critical component of this procedure, as it allows the healthcare provider to accurately visualize the target area and the surrounding anatomical structures. During the procedure, a transducer is placed over the designated site to identify the relevant layers of the chest wall, ensuring that the injection is delivered to the correct location. To enhance safety and accuracy, hydrodissection is employed, which involves the injection of saline in front of the needle tip. This technique creates a visible halo effect that aids in confirming the correct positioning of the needle within the fascial plane, thereby minimizing the risk of intramuscular injection. Once the appropriate position is confirmed, the block needle is advanced into the interfascial plane, where the local anesthetic is then injected unilaterally. This targeted approach is particularly beneficial for patients undergoing thoracic surgeries, as it can significantly improve their post-operative recovery experience by managing pain effectively and reducing the need for systemic opioids.

1. Indications

The thoracic fascial plane block is indicated for patients undergoing chest surgery who require effective post-operative pain management. The procedure is particularly beneficial for those who may be at risk of opioid-related side effects or complications, as it aims to reduce the need for opioid analgesics. Specific indications include:

Post-operative Pain Management This block is performed to control pain following surgical procedures on the chest, such as thoracotomy or video-assisted thoracoscopic surgery (VATS).
Reduction of Opioid Use The procedure is indicated for patients who need to minimize opioid consumption due to potential side effects or previous history of opioid dependence.

2. Procedure

The thoracic fascial plane block involves several key procedural steps to ensure accurate delivery of the local anesthetic. These steps include:

Step 1: Ultrasound Guidance The procedure begins with the application of ultrasound guidance. A transducer is placed over the target area on the chest wall to visualize the relevant anatomical structures and layers. This imaging is crucial for identifying the correct location for the injection.
Step 2: Hydrodissection Hydrodissection is performed as a safety measure. Saline is injected in front of the needle tip to create a halo effect, which helps in visualizing the needle's position within the fascial plane. This step is essential for confirming that the needle is not intramuscularly positioned.
Step 3: Needle Advancement Once the correct position is confirmed through hydrodissection, the block needle is advanced into the interfascial plane. This precise placement is critical for the effectiveness of the block.
Step 4: Injection of Local Anesthetic After the needle is properly positioned, a local anesthetic is injected unilaterally into the fascial plane. This injection is intended to provide targeted pain relief for the surgical site.

3. Post-Procedure

After the thoracic fascial plane block is performed, patients are typically monitored for any immediate adverse reactions to the local anesthetic. Expected recovery includes a reduction in post-operative pain, allowing for improved mobility and comfort. Patients may be advised on pain management strategies and the potential need for follow-up care. It is important to assess the effectiveness of the block and to monitor for any complications, such as infection or hematoma formation at the injection site. Additionally, patients should be informed about the signs of local anesthetic toxicity and when to seek medical attention.

Short Descr	THRC FASCIAL PLN BLK UNI NJX
Medium Descr	THORACIC FASCIAL PLANE BLOCK UNI INJECTION
Long Descr	Thoracic fascial plane block, unilateral; by injection(s), 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	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)	none
MUE	Not applicable/unspecified.