CPT® Code 64473

Official Description

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

Common Language Description

A lower extremity fascial plane block is a medical procedure designed to alleviate post-operative pain and minimize the reliance on opioid medications following surgical interventions on the lower limb, such as knee or hip arthroplasty. This procedure involves the precise injection of a local anesthetic into the fascial plane of the lower extremity, which is the connective tissue that surrounds muscles and other structures. The use of continuous ultrasound guidance is a critical component of this procedure, as it allows the healthcare provider to visualize the target area in real-time. During the procedure, a transducer is placed over the designated site to identify the relevant anatomical structures and tissue layers, ensuring accurate placement of the injection. The technique includes hydrodissection, a method where saline is injected to create a space that helps in visualizing the needle's position, thereby enhancing safety and accuracy. This technique is particularly important as it helps to avoid intramuscular injections, which could lead to complications or ineffective pain relief. The block needle is then carefully advanced between the target fascia and the underlying muscle, such as the iliac muscle and fascia, where the local anesthetic is administered. This targeted approach is essential for achieving effective pain control in patients recovering from lower limb surgeries.

1. Indications

The lower extremity fascial plane block is indicated for patients undergoing surgical procedures on the lower limb, particularly those who may experience significant post-operative pain. The following conditions and scenarios warrant the use of this block:

Knee Arthroplasty - This procedure is commonly performed to relieve pain and restore function in patients with severe knee arthritis or joint damage.
Hip Arthroplasty - Similar to knee arthroplasty, this surgery is aimed at alleviating pain and improving mobility in patients suffering from hip joint issues.
Post-operative Pain Management - The block is utilized to manage pain effectively after various lower limb surgeries, reducing the need for opioid analgesics.

2. Procedure

The procedure for administering a lower extremity fascial plane block involves several critical steps to ensure accuracy and effectiveness:

Step 1: Patient Positioning - The patient is positioned appropriately to allow optimal access to the lower extremity, ensuring comfort and safety during the procedure.
Step 2: Ultrasound Guidance - A continuous ultrasound transducer is placed over the target area to visualize the anatomical structures, including the iliac fascia and underlying muscles. This imaging guidance is essential for accurate needle placement.
Step 3: Hydrodissection - Saline is injected in front of the needle tip to create a hydrodissection effect, which helps to delineate the fascial plane and visualize the correct needle position. This step is crucial for avoiding intramuscular injections.
Step 4: Needle Insertion - The block needle is advanced carefully between the identified fascia and the muscle, such as the iliac muscle and fascia, ensuring that it is positioned correctly within the fascial plane.
Step 5: Injection of Local Anesthetic - Once the needle is in the correct position, a local anesthetic is injected into the fascial plane to provide pain relief. This step is vital for achieving the desired analgesic effect post-surgery.

3. Post-Procedure

After the lower extremity fascial plane block is performed, patients are typically monitored for any immediate adverse reactions to the anesthetic. It is essential to assess the effectiveness of the block in managing post-operative pain. Patients may experience numbness or weakness in the lower limb, which is expected and should resolve as the anesthetic wears off. Follow-up care may include instructions on pain management, mobility, and any necessary rehabilitation exercises to promote recovery. Additionally, healthcare providers should ensure that patients are aware of potential side effects and when to seek further medical attention.

Short Descr	LWR XTR FSCL PLN BLK UNI NJX
Medium Descr	LOWER XTR FASCIAL PLANE BLOCK UNI INJECTION
Long Descr	Lower extremity 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.