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The procedure described by CPT® Code 64517 involves the injection of an anesthetic agent into the superior hypogastric plexus, which is a network of nerves located in the lower abdomen. This block is specifically indicated for the management of intractable pain in the pelvic region, which can arise from various conditions, particularly malignant primary and metastatic neoplasms affecting the pelvic area. The superior hypogastric plexus block aims to interrupt pain transmission from the pelvic organs, providing significant relief to patients suffering from chronic pain conditions. The procedure requires careful preparation and precise technique, as it involves the insertion of a spinal needle through the L5-S1 interspace, ensuring that the needle is accurately positioned to avoid critical structures such as the ureters, spinal canal, and blood vessels. The use of radiologic guidance is essential in this procedure to confirm the correct placement of the needle and the effective delivery of the anesthetic agent into the targeted area, ultimately enhancing patient comfort and quality of life.
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The superior hypogastric plexus block is indicated for patients experiencing intractable pain in the pelvic region. This type of pain is often associated with the following conditions:
The procedure for performing a superior hypogastric plexus block involves several critical steps to ensure accuracy and safety. First, the patient's back is prepared over the L5-S1 interspace, which is the targeted entry point for the needle. This preparation may include cleaning the skin with antiseptic solutions to minimize the risk of infection. Next, using separately reportable radiologic guidance, a spinal needle is carefully inserted through the skin and advanced through the L5-S1 interspace. The positioning of the needle is crucial; it must be directed anterolateral to the interspace to reach the superior hypogastric plexus effectively. Once the needle is in place, the clinician aspirates the needle to confirm that the tip is not located within the ureters, spinal canal, or any blood vessels, which is vital for patient safety. Following this confirmation, a radiographic contrast agent is injected to visualize the needle's placement in the pre-vertebral space, specifically anterior to the psoas muscle fascia. This step is essential to ensure that the needle is correctly positioned for the subsequent injection. After verifying the correct placement with the contrast, the needle is aspirated once more, and then a local anesthetic is injected into the targeted area to provide pain relief.
After the superior hypogastric plexus block is performed, patients are typically monitored for any immediate adverse reactions to the anesthetic agent. It is important to assess the effectiveness of the block in relieving pain and to observe for any potential complications. Patients may experience temporary numbness or weakness in the pelvic region, which should be explained as a normal effect of the anesthetic. Follow-up care may include instructions on activity restrictions and pain management strategies. The expected recovery time can vary, but many patients may experience significant pain relief shortly after the procedure, contributing to improved quality of life.
| Short Descr | N BLOCK INJ HYPOGAS PLXS | Medium Descr | INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS | Long Descr | Injection, anesthetic agent; superior hypogastric plexus | 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) | 0 - 150% payment adjustment for bilateral procedures 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 | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 8 - Other non-OR or closed therapeutic nervous system procedures |
This is a primary code that can be used with these additional add-on codes.
| 77003 | CPT Add On MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) |
| 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 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. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 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.) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | LT | Left side (used to identify procedures performed on the left side of the body) | 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 | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | 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 | 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 | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| 2004-01-01 | Added | First appearance in code book in 2004. |
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