CPT® Code 64468

Official Description

Thoracic fascial plane block, bilateral; 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 area within the chest wall. The use of continuous ultrasound guidance is a critical component of this procedure, as it allows the healthcare provider to visualize the target area accurately. During the procedure, a transducer is placed over the designated site to identify the relevant anatomical structures and layers of the chest wall. Hydrodissection, a technique that involves the injection of saline, is employed as a safety measure to ensure the correct positioning of the needle before the anesthetic is administered. This technique creates a halo effect around the needle tip, enhancing visibility and confirming that the needle is in the appropriate space, thereby minimizing the risk of intramuscular injection. The thoracic fascial plane block can be performed bilaterally, meaning that injections are administered on both sides of the chest, which is indicated by the CPT® Code 64468. This code is specifically used when the block is injected bilaterally, while other codes are designated for different methods of administration, such as continuous infusion through a catheter.

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. The following conditions may warrant the use of this block:

Post-operative Pain Management Effective control of pain following thoracic surgical procedures.
Reduction of Opioid Use Minimizing the reliance on opioids for pain relief, thereby decreasing the risk of opioid-related adverse effects.

2. Procedure

The thoracic fascial plane block procedure involves several critical steps to ensure accurate placement and effective pain relief. The following procedural steps are outlined:

Step 1: Ultrasound Guidance The procedure begins with the application of continuous ultrasound guidance. A transducer is positioned over the target area of the chest wall to visualize the relevant anatomical structures and layers. This imaging technique is essential for ensuring precise needle placement.
Step 2: Hydrodissection Hydrodissection is performed as a safety measure. Saline is injected in front of the needle tip, creating a halo effect that helps visualize the needle's position within the fascial plane. This step is crucial for confirming that the needle is correctly positioned and avoiding intramuscular injection.
Step 3: Injection of Local Anesthetic Once the correct needle position is confirmed, a local anesthetic is injected into the thoracic fascial plane on one side of the chest. This step is similar to the procedure described in CPT® Code 64466, where the block needle is advanced to the interfascial plane.
Step 4: Bilateral Injection For CPT® Code 64468, the procedure is then repeated on the opposite side of the chest, resulting in bilateral injections. This ensures comprehensive pain management across the thoracic region.

3. Post-Procedure

After the thoracic fascial plane block is performed, patients are typically monitored for any immediate side effects or complications related to the procedure. Expected recovery includes a reduction in post-operative pain, allowing for improved mobility and comfort. Patients may be advised on follow-up care, including monitoring for any signs of infection at the injection sites or unusual symptoms. The effectiveness of the block in reducing pain and the need for opioids will also be assessed during the recovery period.

Short Descr	THRC FASCIAL PLN BLK BI NJX
Medium Descr	THORACIC FASCIAL PLANE BLOCK BI INJECTION
Long Descr	Thoracic fascial plane block, bilateral; 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)	2 - 150% payment adjustment does NOT apply.
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.