CPT® Code 64474

Official Description

Lower extremity fascial plane block, unilateral; by continuous infusion(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 strategic placement of a block within 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 for precise visualization of the target area. During the procedure, a transducer is positioned over the designated site to identify the relevant anatomical structures and tissue layers, ensuring that the block is administered in the most effective location, typically within the iliac fascia. To enhance safety and accuracy, hydrodissection is employed, which involves the injection of saline in front of the needle tip. This technique creates a visual halo that aids in confirming the correct needle position within the fascial plane, thereby reducing the risk of intramuscular injection. Once the appropriate position is confirmed, a local anesthetic is injected to achieve the desired analgesic effect. In the case of CPT® Code 64474, the procedure is further advanced by the use of a catheter for continuous infusion of local anesthetic, providing sustained pain relief. This method not only improves patient comfort but also supports a more effective recovery process following lower limb surgeries.

1. Indications

The lower extremity fascial plane block is indicated for patients undergoing surgical procedures on the lower limb, particularly those involving the knee or hip. The primary purpose of this block is to manage post-operative pain effectively and to reduce the need for opioid analgesics, which can have significant side effects and risks associated with their use. This procedure is particularly beneficial for patients who may be at higher risk for opioid-related complications or those who prefer to minimize opioid consumption during their recovery.

Post-operative pain management This block is utilized to control pain following surgeries such as knee or hip arthroplasty.
Reduction of opioid use The procedure aims to decrease the reliance on opioid medications for pain relief, thereby minimizing potential side effects.

2. Procedure

The procedure for a lower extremity fascial plane block involves several critical steps to ensure accurate placement and effective pain management.

Step 1: Ultrasound Guidance The procedure begins with the application of continuous ultrasound guidance. A transducer is placed over the target area of the lower extremity to visualize the relevant anatomical structures and tissue layers. This imaging technique is essential for identifying the most appropriate plane of the iliac fascia.
Step 2: Hydrodissection Hydrodissection is performed as a safety measure to confirm the correct needle position before administering the block. Saline is injected in front of the needle tip, creating a halo effect that helps visualize the needle's placement within the fascial plane, ensuring that it does not enter the muscle tissue.
Step 3: Needle Advancement Following hydrodissection, the block needle is advanced between the target fascia and the adjacent muscle, such as the iliac muscle and fascia. This step is crucial for ensuring that the local anesthetic will be delivered to the correct location.
Step 4: Catheter Insertion In CPT® Code 64474, after confirming the correct needle position, a catheter is inserted through the placement needle. The needle is then removed, leaving the catheter in place for continuous infusion.
Step 5: Securing the Catheter The catheter is secured to prevent displacement, and local anesthetic is infused into the target fascial plane through the catheter. This continuous infusion provides ongoing pain relief for the patient during the post-operative recovery period.

3. Post-Procedure

After the lower extremity fascial plane block is performed, patients can expect to experience significant pain relief as the local anesthetic takes effect. Continuous monitoring of the infusion site is essential to ensure that the catheter remains secure and that there are no signs of complications, such as infection or catheter displacement. Patients may be advised on specific post-procedure care instructions, including how to manage the infusion and when to seek medical attention if they experience any adverse effects. The goal of this procedure is to facilitate a smoother recovery process, allowing patients to engage in rehabilitation activities with reduced discomfort.

Short Descr	LWR XTR FSCL PLN BLK UNI NFS
Medium Descr	LOWER XTR FASCIAL PLANE BLOCK UNI CONT INFUSION
Long Descr	Lower extremity fascial plane block, unilateral; by continuous infusion(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.