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Lumbar Sympathetic Catheter Placement Under Fluoroscopic guidance (On-Q)

CC Posted Fri 07th of August, 2015 17:36:42 PM

Could someone please let me know if CPT code 64449 would be the correct code for the On-Q pain pump procedure.

Complex regional pain syndrome right foot.
1. Lumbar sympathetic block under fluoroscopic guidance. 2.Lumbar sympathetic catheter placement under fluoroscopic guidance.
The patient is a 61-year-old gentleman with a chief complaint of right foot and right ankle pain diagnosed with complex regional pain syndrome from multiple foot fracture and surgery. The patient had short-term relief from lumbar sympathetic blocks.
He is here for lumbar sympathetic catheter placement for continued infusion for continued sympathetic blockade. The risks and benefits of the procedure were discussed with the patient including bleeding, infection, nerve damage and increased pain. The catheter used was an On-Q pain relief system catheter pump is On-Q 600 ml capacity.
The patient was placed in the prone position with standard monitors. The back was sterilely prepped and draped. Under fluoroscopic guidance AP view the C-arm was tilted obliquely to the right at 20 degrees. Landmark was identified at lower one-third of L2 vertebral body. Infiltration was made with 1% lidocaine. A skin puncture was made with an 18-gauge needle. An 18-gauge bent tip Tuohy needle 6 inches was inserted under fluoroscopic guidance, AP, lateral and oblique view. Needletip's final position was placed at 5 mm medial to the lateral border of the L2 vertebral body under AP view, under lateral view the needletip was 1-2 mm anterior to the anterior border of L2 vertebral body. 1 cc of Isovue M-200 dye was injected. The dye spread along the anterolateral of L2 vertebral body. No signs of intravascular injection. At this time the On-Q catheter was threaded inside the needle under fluoroscopic guidance to 2 cm beyond the needletip. 1 cc of dye was injected through the catheter confirming the catheter tip placement. The needle was removed with the catheter in place. It was secured in place after cover with Bacitracin ointment at the catheter insertion site. It was hooked up to On-Q 600 cc pump of the final concentration of 0.1% preservative-free Ropivacaine. The rate was set at 6 ml per hour. The patient was taken to the recovery room in good condition.

Thanks for the help!

SuperCoder Answered Mon 10th of August, 2015 01:33:34 AM

AAE does not provide coding for operative reports and chart notes.
SuperCoder offers SuperCoding on Demand (SOD) ( for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail for more information.

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