2025 CPT code 64520
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Lumbar or thoracic paravertebral sympathetic nerve block.
Modifiers 50 (bilateral procedure), 22 (increased procedural services), 59 (distinct procedural service), and others may be applicable depending on the circumstances. Consult the CPT manual for appropriate modifier use.
The procedure is medically necessary when conservative treatments for chronic pain have failed.The pain must significantly impact the patient's quality of life. A thorough evaluation ruling out other causes of the pain is required. Documentation of failed conservative treatment attempts must be detailed.
The physician is responsible for patient preparation, proper draping, fluoroscopic guidance for precise needle placement, verification of needle position (including aspiration to avoid intravascular or intrathecal injection), and administration of the local anesthetic. Post-procedure monitoring and follow up care are also under the physician's purview.
In simple words: This procedure numbs specific nerves in the back (paravertebral sympathetic nerves) to relieve pain in the chest, abdomen, or lower body.A doctor uses X-ray guidance to precisely place a needle and inject medicine to block the nerve signals causing pain.
This procedure involves a nerve block of the lumbar or thoracic paravertebral sympathetic nerves, part of the autonomic nervous system's sympathetic division.The provider uses fluoroscopic guidance to carefully insert a needle into the precise location of the sympathetic nerve, after prepping and draping the patient.Needle placement is verified via aspiration to rule out intravascular or intrathecal placement. A local anesthetic is then slowly injected into the targeted paravertebral sympathetic nerves.
Example 1: A patient presents with chronic intractable pain in their abdomen due to pancreatitis. A paravertebral sympathetic nerve block is performed to provide pain relief., A patient experiencing severe pain in their lower extremities due to peripheral vascular disease undergoes a lumbar paravertebral sympathetic nerve block as part of a comprehensive pain management strategy., A patient is scheduled for a major abdominal surgical procedure.A thoracic paravertebral sympathetic nerve block is performed pre-operatively for analgesia.
Detailed medical history including pain location, character, and duration.Radiographic documentation (fluoroscopy images) showing needle placement.Documentation of the type and amount of anesthetic used, as well as the patient's response to the block (pain relief).Post-procedure assessment and follow up care.
** The specific location of the nerve block (thoracic vs. lumbar) must be accurately documented.The use of fluoroscopy is integral to the procedure and should be documented. Careful attention should be paid to appropriate modifier selection based on NCCI guidelines.
- Revenue Code: P5E
- Payment Status: Active
- Modifier TC rule: No TC modifier applicable.
- Specialties:Anesthesiology, Pain Management, Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center