Ipack block cpt code

Anaesthesia Cases walked 550 m during the 6MW test. The patients satisfaction with care was 100 on a 0-100 mm visual analogue scale. Discussion Pain following total knee arthroplasty is often severe and can limit rehabilitation [1].

Ipack block cpt code. Oct 26, 2019 · Although total opioid consumption on POD 0 was lower in patients receiving iPACK plus adductor canal blocks compared with an adductor canal block alone (34 morphine milligram equivalents [MME] vs. 47 MME), the difference was not statistically significant (P=0.166). As Dr. Mariano explained, however, given the robust multimodal analgesic regimen ...

For the iPACK block, a high-frequency ultrasound transducer was used to visualize the popliteal artery and posterior surface of the distal femoral shaft after adductor canal catheter insertion. Using an in-plane approach, a 20-gauge Tuohy needle was inserted from medial to lateral to position the needle tip between the popliteal artery and ...

Background. The combination of adductor canal block (ACB) and infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block may provide sufficient motor-sparing anterior and posterior knee analgesia after total knee arthroplasty.This study aimed to determine if ACB with iPACK block was noninferior to …The Current Procedural Terminology (CPT ®) code 64445 as maintained by American Medical Association, is a medical procedural code under the range - Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Somatic Nerves.64488 - CPT® Code in category: Transversus abdominis plane (TAP) block... CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA. Access to this feature is available in the following products: Find-A-Code Essentials. Based on Medicare rules, regulations, and National Correct Coding Initiative (NCCI) edits, CPT codes 64400-64530 (Peripheral nerve blocks-bolus injection or continuous infusion) may be reported on the date of surgery if performed for post-operative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection or ... Currently, there is no specific CPT code to report an iPACK block. Therefore, code 64999, Unlisted procedure, nervous system, should be reported. It is important to avoid selecting a CPT code that merely approximates the service provided; therefore, if a specific code does notBackground The infiltration between the popliteal artery and the capsule of the knee (IPACK) block has been described as an alternative analgesic strategy for knee pain. Objective Our aim was to perform a narrative review to examine the place and value that the IPACK block has in comparison to and in conjunction with other regional anesthesia modalities. Evidence review Following an extensive ...(ACB) are appropriate blocks for total knee arthroplasty (TKA); however, neither provides posterior knee analgesia, which may lead to inadequate pain control in patients that do not receive a supplemental block to control posterior knee pain. The Infiltration between the Popliteal Artery and the Capsule of the Knee (iPACK) block was introduced ...Looking at the lateral branch nerve is a peripheral nerve and would be reported with CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch, when a lateral branch nerve block is performed. Please note: CPT code 64450 should only be reported per nerve or branch and not per injection.

The iPACK block targets the articular sensory branch of the sciatic nerve while sparing the motor branches of the tibial nerve (TN) and CPN, thereby avoiding the foot drop that occurs with the sciatic nerve block. iPACK is an alternative analgesic adjuvant to femoral or adductor canal block for posterior knee pain. The iPACK block is a motor-sparing analgesic intervention that blocks the articular branches of the tibial, common pero - neal and obturator nerves in the popliteal region. Indications (Patient Selection) The iPACK block is indicated for patients undergoing total knee arthroplasty (TKA). Functional Anaomt y. Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes.Use this page to view details for the Local Coverage Article for Billing and Coding: Nerve Blocks for Peripheral Neuropathy. ... Posted 01/26/2023 Under CPT/HCPCS Codes Group 2 Codes CPT code 76882 had a description change. This revision is due to the Annual 2023/Q1 CPT/HCPCS Code Update and is effective …Ultrasound‐guided SACB combined with IPACK block can be safely applied in TKA in the elderly patients, and the analgesia effect is more complete, and contributing to promote the early rehabilitation. (4) Puncture site infection; (5) Allergic to local anesthetic drugs. Li (2019) 2017.11–2018.04: 30: 30: 66 (6) 69 (6) 21 (70%)The lower Timed Up and Go test scores on postoperative days 1 and 2, along with a shorter duration of hospitalization, were found in the iPACK+LIA+CACB group (p<0.05). Conclusion: The addition of an iPACK block to the LIA and CACB does not reduce the postoperative opioid consumption nor improve analgesia. However, it may improve immediate ...Billing for the Genicular Nerve Branches RFA and Block have been a struggle since it was not too clear on how we should be billing for this service. The good news is, we have a new code for this effective January 1, 2020. ... CPT CODE 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, …It is appropriate to bill CPT code 64999 when a provider performs a procedure on the nervous system that does not have a specific CPT code. The provider should not choose a code that merely approximates the service provided. Instead, they should use the unlisted procedure code 64999 and provide supporting documentation to justify the claim. 6.

Results: Patients who received the IPACK block had less pain in the back of the knee 6 hours after surgery when compared with the sham block: 21.7% vs 45.8%, p<0.01. There was marginal improvement in other pain measures in the first 24 hours after surgery.Purpose of Review In this review, we discuss the essential iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) anatomy, block technique as well as potential complications, contraindications, and relevant literature evaluating the efficacy of the iPACK block. Recent Findings Recent literature supports …Apr 8, 2022 · It depends. by: Julia Kyles, CPC. Effective Apr 8, 2022. Published Apr 8, 2022. Last Reviewed Apr 14, 2022. The American Medical Association and the American Hospital Association agree: Practices should report the Infiltration between the Popliteal artery and Capsule of the Knee block (IPACK) with unlisted code 64999. But Aetna has other ideas. Based on Medicare rules, regulations, and National Correct Coding Initiative (NCCI) edits, CPT codes 64400-64530 (Peripheral nerve blocks-bolus injection or continuous infusion) may be reported on the date of surgery if performed for post-operative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection or ...

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The IPACK block is directed at a tissue plane, not at a specific nerve. Currently, there is no specific CPT code to report an IPACK block. Therefore, code 64999, Unlisted procedure, nervous system, should be reported.The Insider Trading Activity of Harris Gail Block on Markets Insider. Indices Commodities Currencies StocksMedical Coding General Discussion . Wiki 64405 2020 CPT Change. Thread starter amowens854; Start date Nov 13, 2019; Create Wiki Sort by date. A ... For a nerve block injection performed with an anesthetic and steroid combination, code 64999 should not be reported. Rather, a code from the 64400-64450 or 64505-64530 series should be …Background. The combination of adductor canal block (ACB) and infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block may provide sufficient motor-sparing anterior and posterior knee analgesia after total knee arthroplasty.This study aimed to determine if ACB with iPACK block was noninferior to …

Nov 13, 2019. #1. I was going over some of the 2020 CPT changes and came across the code set 64400-64450 code descriptor changes. For example..... 64405 --Injection, anesthetic agent; greater occipital nerve (NOW) 2020 CPT changed to. 64405 --Injection, anesthetic agent and/or steroid; greater occipital nerve (2020) If I am reading it correctly ...Ultrasound-guided SACB combined with IPACK block can be safely applied in TKA in the elderly patients, and the analgesia effect is more complete, and contributing to promote the early rehabilitation. (4) Puncture site infection; (5) Allergic to local anesthetic drugs. Li (2019) 2017.11–2018.04: 30: 30: 66 (6) 69 (6) 21 (70%)PENG (Pericapsular Nerve Group) postoperative pain block CPT coding. Date: Oct 17, 2022. Question: ... CPTA, Jun 20 p14: iPack block, correct reporting. Coding Clinic for HCPCS 4Q 2019 p10: iPack nerve block. CPTA Jul 22 p13: Nerve block clarification. Question ID : 17878.Every year, there are always a lot of code changes to learn about and this year is no exception: CPT® 2023 includes 225 new codes, 93 revised codes, and 75 deleted codes. There are coding and guideline changes in every section of the CPT® 2023 code set, except anesthesia. The most significant changes are to the evaluation and …Although total opioid consumption on POD 0 was lower in patients receiving iPACK plus adductor canal blocks compared with an adductor canal block alone (34 morphine milligram equivalents [MME] vs. 47 MME), the difference was not statistically significant (P=0.166). As Dr. Mariano explained, however, given the robust multimodal analgesic regimen ...Prior to 2020, this procedure was reported with CPT code 64450 – Injection, anesthetic agent; other peripheral nerve or branch (2019 Descriptor). Even though a genicular nerve block requires injection of three (3) nerve branches, previous coding guidance stated that when used to describe a genicular nerve block, code 64450 was to be reported ...The iPACK block targets the articular sensory branch of the sciatic nerve while sparing the motor branches of the tibial nerve (TN) and CPN, thereby avoiding the foot drop that occurs with the sciatic nerve block. iPACK is an alternative analgesic adjuvant to femoral or adductor canal block for posterior knee pain. Specific coding or payment-related issues should be directed to the payer. For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director, at (469) 499-0133 or [email protected] . Nerve Blocks (Digital, Dental, Peripheral, etc.) FAQ. In contrast, the erector spinae is a group of muscles and tendons extending the length, and on both sides, of the spine. It is not a separately identified spinal nerve or branch. Therefore, code 64999, Unlisted procedure, nervous system, would be the most appropriate code to report for this type of procedure, as stated in the January 2018 issue ...Purpose of Review In this review, we discuss the essential iPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) anatomy, block technique as well as potential complications, contraindications, and relevant literature evaluating the efficacy of the iPACK block. Recent Findings Recent literature supports …Popliteal fossa block has also been used as an effective analgesic technique in children. In a study of the efficacy of the popliteal sciatic nerve block (0.75 mL/kg of ropivacaine 0.2%) after foot and ankle surgery, 19 of 20 children required no analgesic agents during the first 8–12 hours postoperatively.This review included randomized controlled trials (RCTs) comparing analgesic outcomes after inclusion of local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block versus pathways without iPACK. Electronic databases (MEDLINE, Cochrane Library, Web of Science, Scopus) were searched from inception to 10/11/2020.

Not sure if this helps, but Aetna requires IPACK blocks to be billed with 64450. If you’re billing 64999, that could be the reason for the denial. At least for Aetna cases. Same. ESP and TAP, best way to see efficacy is to do it in PACU when the patient is in pain.

Purpose The infiltration between the popliteal artery and the capsule of the posterior knee (iPACK) has been described to provide analgesia without loss of muscle strength and is effective in functional recovery. This study compared iPACK + ACB (adductor canal block) with PAI (periarticular infiltration) + ACB and ACB alone in terms …09/13/2020. R2. 07/30/2020 To Article Guidance added the following, “and/or steroid by a qualified health care professional within their scope of practice and deleted the following “into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively easily localized area”.Based on Medicare rules, regulations, and National Correct Coding Initiative (NCCI) edits, CPT codes 64400-64530 (Peripheral nerve blocks-bolus injection or continuous infusion) may be reported on the date of surgery if performed for post-operative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection or ...#Ipack block cpt code code; The only differences identified at baseline in the univariable analyses were a high ASA score (ASA > 2, 61.0% vs 47.9%, p = 0.034), higher incidence of depression (26.3% vs 15.1%, p = 0.024), and a higher Discussion The two groups were well matched (Table 2). Analgesic group counts included 146 in the FNB + LB-PAI ...The iPACK block provides analgesia limited to the posterior aspect of the knee capsule, and therefore it should be viewed as a supplement to the femoral and/or adductor canal block. Additionally, ultrasound (US) imaging of the popliteal vessels and sciatic nerve to avoid their injury during iPACK can be difficult in obese patients. + +Purpose of Review Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as ...CPTA, Jun 20 p14: iPack block, correct reporting. Coding Clinic for HCPCS 4Q 2019 p10: iPack nerve block. CPTA Jul 22 p13: Nerve block clarification. Question ID : 17878.

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Coding Conundrum for Labor Epidurals. BY KELLY DENNIS, MBA, ACS-AN, CANPC, CHCA, CPMA, CPC, CPC-I Perfect Office Solutions, Inc., Leesburg, FL Coders often struggle with new or unique scenarios when it comes to reporting labor epidural services. It is important to communicate with your coders and billers to ensure compliant billing.Medical Coding General Discussion . Wiki 64405 2020 CPT Change. Thread starter amowens854; Start date Nov 13, 2019; Create Wiki Sort by date. A ... For a nerve block injection performed with an anesthetic and steroid combination, code 64999 should not be reported. Rather, a code from the 64400-64450 or 64505-64530 series should be … l artery and capsule of the knee (IPACK) block is a promising emerging analgesic technique. Objective: To describe analgesic control, opioid consumption, and mobility of patients scheduled for TKA using IPACK block as adjunct analgesic to the femoral block. Methods: We conducted a prospective observational cohort study over a 6-month period in adults taken to TKA. Sociodemographic and ... PENG (Pericapsular Nerve Group) postoperative pain block CPT coding. Date: Oct 17, 2022. Question: ... CPTA, Jun 20 p14: iPack block, correct reporting. Coding Clinic for HCPCS 4Q 2019 p10: iPack nerve block. CPTA Jul 22 p13: Nerve block clarification. Question ID : 17878.Background Several studies have suggested that the addition of iPACK block (the popliteal artery and the posterior knee capsule have been given interspace local anesthetic infiltration) might get better analgesia than adductor canal block (ACB) only after total knee arthroplasty (TKA). This paper compiles all available evidence on the effect of two analgesia regimens (ACB and iPACK + ACB ...Thanks to interlocking, stackable blocks, this project can be completed in a weekend. Expert Advice On Improving Your Home Videos Latest View All Guides Latest View All Radio Show ...In the past, CPT code 64421, intercostal nerve block, multiple was a stand-alone code reported when more than one intercostal level was injected. The 2020 CPT …Nov 1, 2016 · Denver, CO. Best answers. 0. Mar 24, 2020. #4. According to the AMA, because the IPACK block is directed as a tissue plane (not at a specific nerve) and blocks several nerves, it is coded to unlisted code 64999 Unlisted procedure, nervous system. Block at a Glance Infiltration around the sensory branches that provide innervation to the knee joint (genicular nerves) before they enter the knee capsule. Indications: Chronic knee pain, total knee arthroplasty, or procedures associated with moderate to severe postoperative knee pain Goal: Local anesthetic spread next to the genicular arteries (if … ….

This review included randomized controlled trials (RCTs) comparing analgesic outcomes after inclusion of local anesthetic infiltration between the popliteal artery and capsule of the knee (iPACK) block versus pathways without iPACK. Electronic databases (MEDLINE, Cochrane Library, Web of Science, Scopus) were searched from inception to 10/11/2020.The femoral nerve block (one of the most common nerve blocks, according to a recent ABC client survey) is coded with CPT code 64447 for a single injection and 64448 for a catheter insertion.Paravertebral block – 64461-64463 Piriformis muscle – 20552 Popliteal block – 64445 Saphenous block – 64447-64448 Sphenopalatine Ganglion – 64505 TAP (Transverse Abdominis Plane block – 64486-64489. Nerve Block procedures reported with 64999 Unlisted procedure, nervous system. Erector Spinae Plane block Ganglion Impar …Purpose: Combination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation. Interspace between the popliteal artery and the capsule of the posterior knee block (IPACK) has been introduced clinically. We evaluated the efficacy of IPACK in …There was a lower incidence of posterior knee pain (39%) in the IPACK group when compared with controls (8.7%), p < 0.01. In terms of opioid consumption and a majority of functional outcomes, our study demonstrates no overall benefits of adding an IPACK block in this ERAS pathway in TKA.We would like to show you a description here but the site won’t allow us. someone else you’d rather not hear from, there are probably a few phoneIn the course of doing business in the real world, 'blocking' you socially might amount to someone refusing to talk with you on the phone or rejecting offers to meet in person. In ... Ipack block cpt code, In contrast, the erector spinae is a group of muscles and tendons extending the length, and on both sides, of the spine. It is not a separately identified spinal nerve or branch. Therefore, code 64999, Unlisted procedure, nervous system, would be the most appropriate code to report for this type of procedure, as stated in the January 2018 issue ..., PENG (Pericapsular Nerve Group) postoperative pain block CPT coding. Date: Oct 17, 2022. Question: ... CPTA, Jun 20 p14: iPack block, correct reporting. Coding Clinic for HCPCS 4Q 2019 p10: iPack nerve block. CPTA Jul 22 p13: Nerve block clarification. Question ID : 17878., In summary, facial plane blocks that do not have their own CPT code are now required to be reported with unlisted CPT code 64999. Other peripheral nerve blocks (such as radial, ulnar, common fibular, peroneal, etc.) are to be reported with 64450 (Injection (s), anesthetic agent (s) and/or steroid; other peripheral nerve or branch)., Based on Medicare rules, regulations, and National Correct Coding Initiative (NCCI) edits, CPT codes 64400-64530 (Peripheral nerve blocks-bolus injection or continuous …, 64488 - CPT® Code in category: Transversus abdominis plane (TAP) block... CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. CPT code information is copyright by the AMA. Access to this feature is available in the following products: Find-A-Code Essentials., Based on Medicare rules, regulations, and National Correct Coding Initiative (NCCI) edits, CPT codes 64400-64530 (Peripheral nerve blocks-bolus injection or continuous infusion) may be reported on the date of surgery if performed for post-operative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection or ..., Specific coding or payment-related issues should be directed to the payer. For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director, at (469) 499-0133 or [email protected] . Nerve Blocks (Digital, Dental, Peripheral, etc.) FAQ., Coding: IPACK is reported with the unlisted code according to CPT Assistant 6/2020. The abductor block would be reported with 64447 and that would …, Four codes in the CPT code set describe transversus abdominis plane (TAP block): 64486- 64489. Codes 64486 and 64487 are used to report a unilateral TAP block. Codes 64488 and 64489 are reported for the administration of a bilateral TAP block. These codes distinguish injection (64486, 64488) from continuous infusion (64487, 64489)., 00:00 Introduction00:10 Anatomy1:05 Technique🖥 Start your 7-day free trial on the NYSORA LMS today and see why it is the go-to resource to master Regional A..., Transversalis Fascia Plane Block. The transversalis fascia plane block, or TFP block, is a truncal block that targets the L1 nerve branches, namely the ilioinguinal and iliohypogastric nerves.The ilioinguinal and iliohypogastric nerves emerge from the lateral border of psoas major muscle, inferior to the 12 th rib, and course over the anterior ..., The pericapsular nerve group block (PENG) is a regional anesthetic technique described in 2018, developed primarily in total hip arthroplasties (THA) for postoperative analgesia with motor sparing benefits. The block is thought to provide more complete analgesia to the hip by depositing local anesthetic within the myofascial plane …, The Current Procedural Terminology (CPT ®) code 64446 as maintained by American Medical Association, is a medical procedural code under the range - Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Somatic Nerves. , iPACK block Interspace between the popliteal artery and posterior capsule of the knee Terminal articular branches to the knee from the posterior tibial nerve, articular branches …, The interspace between the popliteal artery and posterior capsule of the knee (IPACK) block is an analgesic method for treating posterior knee pain in patients undergoing total knee arthroplasty (TKA).1,2,3 Anesthesiologists administer the IPACK block in combination with a femoral nerve block (FNB) or adductor canal block (ACB) …, IPACK block reduced the incidence of posterior knee pain 6 h postoperatively. Given the relative ease and safety profile, it may have a potential role as part of the multimodal analgesia after knee arthroplasty, particularly as a distinct alternative to sciatic nerve blockade that does not affect motor function. The IPACK block can also …, 01/01/2020. R3. The billing and coding article for the Nerve Blockade for Treatment of Chronic Pain and Neuropathy Policy Local Coverage Determination (LCD) is revised to add CPT code 64451, effective January 1, 2020. The following CPT code descriptors were changed in group 1: 64405, 64408, 64415, 64417, 64418, 64420, …, A novel nerve block technique described by Sanjay Sinha, MD, from Hartford, CT, is an ultrasound (US)-guided local anesthetic injection between the popliteal artery and the capsule of the knee (IPACK).17 By targeting only the terminal branches of the sciatic nerve, the IPACK block provides an alternative for decreasing, Background: Periarticular injections (PAIs) are becoming a staple component of multimodal joint pathways. Motor-sparing peripheral nerve blocks, such as the infiltration between the popliteal artery and capsule of the posterior knee (IPACK) and the adductor canal block (ACB), may augment PAI in multimodal analgesic pathways for knee arthroplasty, but …, For the iPACK block, a high-frequency ultrasound transducer was used to visualize the popliteal artery and posterior surface of the distal femoral shaft after …, CPT stands for Current Procedural Terminology and is administered by the AMA (American Medical Association). HCPCS stands for Healthcare Common Procedural Coding System and is base..., IPACK block is a valuable technique for analgesia in patients having total knee replacement if your surgeons are not using intraoperative infiltration with t..., Indications: Analgesia after knee arthroplasty, cruciate ligament repair, and procedures involving the posterior aspect of the knee. Goal: Local anesthetic infiltration over the posterior aspect of the femur underneath the popliteal artery. Local anesthetic volume: 15 to 20 mL., Peripheral nerve blocks are administered as an injection of a local anesthetic (such as bupivacaine or lidocaine) with or without adjuvants (such as steroids) near peripheral nerves or a nerve ganglion. ... Updated Coding section with 01/01/2023 CPT changes; revised descriptors for 64415, 64417, 64447. Reviewed. 02/17/2022. …, Results: Post-implementation, 48/50 (96%) of TKA patients received an IPACK block, and they were compared with 32 patients in the PRE group. On POD 0, the lowest pain score (median [10th-90th percentiles]) was significantly lower for the POST group compared to the PRE group (0 [0-4.3] vs. 2.5 [0-7]; P = 0.003). , The Current Procedural Terminology (CPT ®) code 64416 as maintained by American Medical Association, is a medical procedural code under the range - Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Somatic Nerves., Four codes in the CPT code set describe transversus abdominis plane (TAP block): 64486- 64489. Codes 64486 and 64487 are used to report a unilateral TAP block. Codes 64488 and 64489 are reported for the administration of a bilateral TAP block. These codes distinguish injection (64486, 64488) from continuous infusion (64487, 64489). , The Current Procedural Terminology (CPT ®) code 64416 as maintained by American Medical Association, is a medical procedural code under the range - Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Somatic Nerves. , The hospital stay was also shorter in the iPACK group than in the TNB group. Considering early mobilization and earlier discharge, iPACK block may be a preferred motor-sparing alternative to TNB with a lower incidence of foot drop and an increased likelihood. Drop foot was observed in 2 of 411 patients who underwent iPACK …, Results: Post-implementation, 48/50 (96%) of TKA patients received an IPACK block, and they were compared with 32 patients in the PRE group. On POD 0, the lowest pain score (median [10th-90th percentiles]) was significantly lower for the POST group compared to the PRE group (0 [0-4.3] vs. 2.5 [0-7]; P = 0.003). , Aug 17, 2018. #3. 76942 (x2) with 64447 & 64448. I have billed Medicare (Novitas) for CPT 64447 WITH 76942 (Ultra Sound Guidance) and CPT 64448 WITH 76942 for POST OP pain after a Total Knee Replacement. Modifier 26 is added to CPT 76942 for both line items. Each procedure is reported as a separate line item., Background and objective: An ultrasound-guided anesthetic technique targeting the interspace between the popliteal artery and capsule of the posterior knee (iPACK) can provide posterior knee analgesia with preserved motor function after total knee arthroplasty (TKA). This study compared the peroneal nerve motor-sparing effects of iPACK block …, The iPACK block targets the articular sensory branch of the sciatic nerve while sparing the motor branches of the tibial nerve (TN) and CPN, thereby avoiding the foot drop that occurs with the sciatic nerve block. iPACK is an alternative analgesic adjuvant to femoral or adductor canal block for posterior knee pain.