A paravertebral or paraspinous blocks is a unilateral block of the spinal nerve, including the dorsal and ventral rami, as well as the sympathetic chain ganglion. These blocks can be performed at any vertebral level, but are commonly performed at the thoracic level because of anatomic considerations. In 2016, CPT® added three new codes for pain management procedures pertaining to the nervous system for paravertebral nerve blocks.
Here’s a look at the 3 new codes:
| CPT Code | Description |
| 64461 | Paravertebral block (PVB) (paraspinous block) thoracic; single injection site (includes imaging guidance, when performed) |
| + 64462 | second and any additional injection site(s) (includes imaging guidance, when performed)(list separately in addition to code for primary procedure) |
| 64463 | continuous infusion by catheter (includes imaging guidance, when performed) |
Code 64461 and 64462
The Paravertebral blocks and continuous infusion can be used for the benefit of pain management for patients undergoing thoracic, breast, and upper abdominal surgery. The idea is to provide a dense, ipsilateral somatic and sympathetic blockade as an analgesic alternative to a neuraxial blockade. The Paravertebral blocks target the sympathetic chain of nerves and multiple intercostals nerves and spinal nerves and their branches, and may be used for dermatomal coverage from T2-L1.
CPT code 64461 is to be reported for the performance of a single injection. Because this procedure includes imaging guidance if it is performed, hence do not report that procedure separately. In case, when additional injections are performed, CPT code + 64462 should be reported.
Note: Code 64462 cannot be reported more than one time per day.
Code 64463
CPT Code 64463 is reported when a provider places a catheter tip in the paravertebral or paraspinous space at the thoracic spine for attachment to an external drug delivery system. Providers use these systems for continuous infusion of drugs like anesthetics, opioids, or steroids.
Note: The use of imaging guidance, both ultrasound CPT 76942 and Fluoroscopy 77002 and 77003 are included and not reported separately.
Your documentation should support time of placement, performing provider and the procedure details itself. Plus, these new codes may be reported as long as they are not the mode of anesthesia for the case, and meet the criteria for separate reporting (i.e., for postoperative pain management at the request of the surgeon).
For more insights on 2016 trends and changes on Pain Management Coding and compliance, check out our upcoming Pain Management Audio conference by expert Trish Bukauskas.
