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Official Description

Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The transversus abdominis plane (TAP) block is a regional anesthesia technique that targets the nerves supplying the anterior abdominal wall, specifically at the spinal levels of T6 to L1. This procedure is primarily utilized to manage postoperative pain in patients undergoing abdominal surgeries. By delivering anesthesia to the area, the TAP block serves as an adjunct therapy, enhancing pain control and potentially reducing the need for systemic opioids. The TAP block can be administered at various stages of the surgical process, including preoperatively, intraoperatively, or postoperatively, depending on the clinical scenario and the surgeon's preference. In cases where the surgical incision is positioned laterally, a unilateral TAP block is often preferred, as it effectively numbs the nerves on one side of the abdomen. Conversely, when the incision is made along the midline, a bilateral TAP block is indicated to ensure adequate pain relief on both sides. The procedure typically involves the injection of a long-acting local anesthetic, such as bupivacaine, which can provide significant pain relief for an extended duration—up to 36 hours for a single injection and potentially longer with continuous infusion techniques. Ultrasound guidance is frequently employed during the TAP block procedure, allowing for precise visualization of the anatomical structures involved, including the layers of muscle and fascia. This imaging technique enhances the accuracy of needle placement and the effectiveness of the anesthetic delivery. Overall, the TAP block is a valuable tool in the management of postoperative pain, contributing to improved patient comfort and recovery outcomes following abdominal surgery.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The transversus abdominis plane (TAP) block is indicated for the following conditions:

  • Postoperative Pain Management This procedure is commonly performed to provide effective pain relief following abdominal surgeries, thereby reducing the reliance on systemic opioids.
  • Adjunct Therapy in Abdominal Surgery The TAP block serves as an adjunct to general anesthesia, enhancing overall pain control during and after surgical procedures.
  • Specific Surgical Incisions A unilateral TAP block is indicated for surgical incisions located to the right or left of the midline, while a bilateral block is appropriate for midline incisions.

2. Procedure

The procedure for performing a transversus abdominis plane (TAP) block involves several key steps, which can vary slightly depending on whether a unilateral or bilateral block is being performed.

  • Step 1: Patient Positioning The patient is positioned appropriately, typically in a supine position, to allow access to the abdominal area for the injection.
  • Step 2: Identification of Injection Site For a unilateral TAP block, the triangle of Petit is identified. This anatomical landmark is located cephalad to the iliac crest and near the midaxillary line.
  • Step 3: Needle Insertion A needle is inserted perpendicular to the skin at the identified site. The needle is advanced through the external and internal abdominal oblique muscles until it reaches the fascia above the transversus abdominis muscle.
  • Step 4: Injection of Local Anesthetic Local anesthetic is injected at measured intervals, with aspiration performed to confirm that the needle is not within a blood vessel. This step is crucial to ensure the safety and efficacy of the block.
  • Step 5: Bilateral Injection For a bilateral TAP block, the procedure is repeated on the opposite side of the abdomen, ensuring that both sides receive adequate anesthesia.
  • Step 6: Continuous Infusion Setup (if applicable) In cases where a continuous infusion is desired, ultrasound guidance is utilized to visualize the layers of muscle and fascia. A Tuohy needle is inserted into the skin and advanced into the fascia above the transversus abdominis muscle.
  • Step 7: Hydrodissection The transversus abdominis plane (TAP) is hydrodissected using 10 ml of isotonic saline to create a space for the catheter.
  • Step 8: Catheter Placement An epidural catheter is introduced through the Tuohy needle and advanced 10 to 20 cm into the TAP. The Tuohy needle is then removed, and the catheter is secured to the skin.
  • Step 9: Anesthetic Administration A bolus injection of local anesthetic is administered through the catheter, and the placement is monitored using ultrasound to confirm proper positioning.
  • Step 10: Finalization Once the catheter is confirmed in place, it is secured, and the procedure is repeated on the opposite side for a bilateral block if necessary.

3. Post-Procedure

After the transversus abdominis plane (TAP) block procedure, patients are monitored for any immediate complications or adverse reactions to the anesthetic. The expected recovery period may vary, but patients typically experience significant pain relief for up to 36 hours following a single injection, or longer with continuous infusion. It is essential to provide instructions for postoperative care, including monitoring for signs of infection at the injection site and managing any potential side effects. Continuous infusion or intermittent bolus injections of anesthetic may be administered as needed to maintain effective pain control. Follow-up assessments should be conducted to evaluate the effectiveness of the block and to address any ongoing pain management needs.

Short Descr TAP BLOCK BI INJECTION
Medium Descr TAP BLOCK BILATERAL BY INJECTION(S)
Long Descr Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (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) 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) 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.
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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
GC This service has been performed in part by a resident under the direction of a teaching physician
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
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
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).
47 Anesthesia by surgeon: regional or general anesthesia provided by the surgeon may be reported by adding modifier 47 to the basic service. (this does not include local anesthesia.) note: modifier 47 would not be used as a modifier for the anesthesia procedures.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
AG Primary physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
Q3 Live kidney donor surgery and related services
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
QZ Crna service: without medical direction by a physician
X2 Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
55 Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
FP Service provided as part of family planning program
GA Waiver of liability statement issued as required by payer policy, individual case
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
GZ Item or service expected to be denied as not reasonable and necessary
LT Left side (used to identify procedures performed on the left side of the body)
PN Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
PT Colorectal cancer screening test; converted to diagnostic test or other procedure
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q5 Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
U7 Medicaid level of care 7, as defined by each state
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2015-01-01 Added Added
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