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COVERAGE POLICY:
AmeriHealth Caritas considers the use of a continuous peripheral nerve block for the management of chronic pain in an
ambulatory setting to be investigational and, therefore, not medically necessary.
For Medicare members:
AmeriHealth Caritas considers the use of a continuous peripheral nerve block to be reasonable and necessary for
treatment of Medicare members with (Local Coverage Decisions L37641, L35456, and L35457):
Chronic pain conditions or hyperhidroses that respond to nerve blocks (e.g., celiac block for pain of
pancreatic cancer).
Peripheral nerve injuries/entrapment or other extremity trauma leading to complex regional pain syndrome.
AmeriHealth Caritas considers the use of a continuous peripheral nerve block to be not medically necessary for chronic
pain associated with metabolic peripheral neuropathy (Local Coverage Articles A52725 and A56034).
For any determinations of medical necessity for medications, refer to the applicable state approved pharmacy policy.
LIMITATIONS:
Effective Date: December 1, 2017
Initial Review Date: October 19, 2017
Recent Review Date: April 2, 2019
Next Review Date: April 1, 2020
Clinical Policy ID: CCP.1347
Clinical Policy Title: Ambulatory continuous peripheral nerve block for chronic pain
Policy Contains: Chronic pain; nerve block; perineural infusion
About this policy:
AmeriHealth Caritas has developed clinical policies to assist with making coverage determinations. AmeriHealth Caritas’s clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by AmeriHealth Caritas when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. AmeriHealth Caritas’s clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. AmeriHealth Caritas’s clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, AmeriHealth Caritas will update its clinical policies as necessary. AmeriHealth Caritas’s clinical policies are not guarantees of payment.
CORP- CCP.1347 2
None.
ALTERNATIVE COVERED SERVICES:
Standards of care involve a range of multimodal approaches depending on pain severity and underlying condition,
including but not limited to:
Non-pharmacologic interventions (e.g., acupuncture, physical therapy and exercise, cognitive behavioral
therapy, and mindfulness meditation).
Systemic opioid and non-opioid pharmacotherapy.
Local anesthetic injections.
Epidural or intrathecal regional infusions.
Neuroablation.
Neurostimulation.
Surgical intervention.
BACKGROUND:
Chronic pain is a significant and underreported health problem, particularly among persons of African American and
Hispanic ethnicity, of lower income and education, with cognitive impairment, and after surgery, and in pediatric
populations (Blackwell, 2014; Ilfeld, 2011; Institute of Medicine, 2011). Those with an underlying propensity or increased
risk for chronic pain are also at risk for under-treatment, as chronic pain can be challenging to treat.
The goals of treatment are to decrease pain intensity and functional outcomes (National Academies of Sciences,
Engineering, and Medicine, 2017). Prescription opioids are effective analgesics for chronic pain, but their long-term use
is associated with an increased risk of opioid use disorder, death from opioid overdose, and other adverse outcomes
(e.g., cardiovascular events or fractures). In the context of the growing opioid problem, reducing the burden of suffering
from chronic pain poses a significant public health challenge. The National Academies of Sciences, Engineering, and
Medicine (2017) proposed multidisciplinary and multimodal non-opioid approaches to reduce the burden of opioid
misuse and abuse and manage pain more effectively.
Interventional neuromodulation therapies deliver pharmaceutical agents, electrical signals, or other forms of energy
directly to the pain source, and are reversible, thereby avoiding side effects associated with more systemic or
irreversible treatments. They increase the flexibility of both duration and density of local anesthetic effect depending on
the chosen dose. A peripheral nerve block is neuromodulatory therapy delivered as a single injection or by continuous
infusion. Single-injection peripheral nerve block offers effective pain relief for up to 24 hours but requires a dense motor
block, and important sensory loss must be taken into account (Aguirre, 2012).
A continuous peripheral nerve block comprises an indwelling catheter, a long-acting local anesthetic, and an infusion
pump (Aguirre, 2012). Guided by nerve stimulation, ultrasound, paresthesia induction, fluoroscopic imaging, or simple
tactile perceptions, the catheter is inserted percutaneously in the proximity of the target nerve to deliver local
anesthetic, most commonly bupivacaine and ropivacaine (Aguirre, 2012; Ilfeld, 2017). Multiple small portable infusion
pumps are available, each with benefits and limitations. It is most often used for post-surgical pain control in the
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hospital setting, but lightweight, portable pumps allow for ambulatory infusion as well. A continuous peripheral nerve
block offers adjustments of volume or concentration of local anesthetic, which reduces the need for a large initial bolus,
lowers the risk of systemic toxicity, falls, and positioning injury, and potentially improves patient outcome (Aguirre,
2012).
FINDINGS:
We identified three narrative reviews (Aguirre, 2012; Ilfeld, 2011, 2017) and seven evidence-based guidelines
(Blumenfeld, 2013; Horlocker, 2010; National Comprehensive Cancer Network, 2017; Neal, 2015; Manchikanti, 2013;
Martelletti, 2013; Paice, 2016). The overwhelming majority of studies of continuous peripheral nerve block involve
perioperative analgesia in adults and is the only application validated with randomized controlled trials. Low-quality,
retrospective studies have described experience with continuous peripheral nerve block in hundreds of pediatric post-
surgical patients (Ilfeld, 2011).
Ambulatory continuous peripheral nerve block for perioperative pain control is at least as effective as sham, single-
injection peripheral nerve blocks, and neuraxial routes of analgesia for controlling pain, decreasing opioid consumption
and opioid-related side effects, decreasing nausea, and providing greater patient satisfaction (Bingham, 2012).
Prolonged benefits of regional anesthesia after catheter removal were reported in a minority of patients. Evidence of
long-term outcomes such as decreased chronic pain and improved health-related quality of life are lacking (Aguirre,
2012; Bingham, 2012).
The evidence of ambulatory continuous peripheral nerve block for chronic pain indications is anecdotal, consisting of
case reports and small case series describing continuous peripheral nerve block in adult and pediatric populations for
complex regional pain syndrome, intractable phantom limb pain, terminal cancer pain, trigeminal neuralgia, postsurgical
chronic (> three months) pain syndromes, ischemia-induced pain, and ulcer-derived pain (Ilfeld, 2011, 2017). The
evidence suggests continuous peripheral nerve block is feasible and may offer effective analgesia for certain chronic pain
types that would respond to a peripheral nerve block, but the relative safety or efficacy to other treatment options,
optimal delivery, or patient selection criteria cannot be determined.
The experience with ambulatory continuous peripheral nerve block in the perioperative pain settings offers some insight
into its potential use for chronic pain. Regardless of technique or block location, major complications of peripheral nerve
block, though rare, include vascular puncture and bleeding, nerve damage, infection, and local anesthetic systemic
toxicity; minor complications involve catheter dislodgement, obstruction, and fluid leakage at the catheter site (Aguirre,
2012). Ambulatory support systems that are evidence-based and incorporate rapid diagnosis and early treatment
algorithms can positively influence patient outcomes (Neal, 2015).
The complexity associated with an indwelling catheter and pump assembly raises the likelihood of technique failure.
Successful home use of continuous peripheral nerve block depends on appropriate patient selection, adequate
ambulatory care support to detect and address adverse events promptly, and education on pump management and
catheter removal (Aguirre, 2012). While age alone is not an absolute exclusion criterion, patients for whom continuous
peripheral nerve block may not be appropriate include those with (Ilfeld, 2011):
Known renal and hepatic insufficiency to avoid possible local anesthetic toxicity.
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Heart disease, lung disease, or obesity who may not be able to compensate for mild hypoxia or hypercarbia
(interscalene and cervical paravertebral infusions).
Altered mental status or psychosocial issues that prevent understanding of, or cooperation with, protocol
and care requirements.
Inability to be contacted after discharge or to access a medical facility in case of emergency.
Evidence-based guidelines provide little direction on the optimal use of continuous peripheral nerve block in chronic
non-malignant pain care. Where peripheral nerve block is mentioned as a treatment option, guidelines recommend
single-injection peripheral nerve block as an alternative when more conservative treatment has failed, with no specific
mention of continuous delivery systems except when recommending neuraxial techniques (Blumenfeld, 2013;
Horlocker, 2010; Manchikanti, 2013; Martelletti, 2013; Neal, 2015). The American Society of Regional Anesthesia and
Pain (2017) does not mention continuous infusion of peripheral nerve block in their list of treatment options for chronic
pain.
For malignant pain, the American Society of Clinical Oncology (Paice, 2016) recommends peripheral nerve blocks as an
interventional therapy option based on a Cochrane review (Arcidiacono, 2011) demonstrating improved pain and lower
opioid consumption at four weeks in adults receiving a single-injection celiac plexus block for pancreatic cancer pain.
Neither the review nor the guideline specifically mentioned continuous infusion except with neuraxial techniques.
The National Comprehensive Cancer Network (2017) recommends continuous peripheral nerve block as one of several
regional infusion options in adults. Interventional approaches using regional infusions are generally not appropriate in
the presence of ongoing infection, coagulopathy, very short life expectancy, distorted anatomy, patient unwillingness,
medications that increase risk of bleeding, or unavailable technical expertise. Catheter displacement and infection
generally limit use beyond a few days or weeks. The main patient selection criteria are:
Pain that is likely to be relieved with a nerve block (e.g., pancreas/upper abdomen with celiac plexus block
or lower abdomen with superior hypogastric plexus block, or peripheral/plexus nerve).
Inability to achieve adequate analgesia or functional activities of daily living with other pharmacologic
therapy.
Presence of intolerable side effects from other interventions (e.g., opioid titration program).
In 2018, we updated the National Comprehensive Cancer Network guideline on adult cancer pain (2018) and added one
guideline from the American Society of Anesthesiologists and American Society of Regional Anesthesia and Pain
Medicine (2010) that does not mention continuous peripheral nerve blocks for chronic pain management. No policy
changes are warranted. The policy ID was changed from CP# 10.02.06 to CCP.1347.
In 2019, we updated the National Comprehensive Cancer Network guideline on adult cancer pain (2019), with no policy
changes warranted. We identified no other newly published, relevant literature to add to the policy.
BILLING AND CODING:
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Below are National Coverage Determinations, Local Coverage Determinations, and the most commonly submitted codes
subject to this policy. This is not an exhaustive list of codes. Providers are expected to consult the appropriate Centers
for Medicare & Medicaid Services references and coding manuals, and bill accordingly.
NATIONAL COVERAGE DETERMINATIONS:
No National Coverage Determinations were identified as of the writing of this policy.
LOCAL COVERAGE DETERMINATIONS:
A52725 Peripheral Nerve Blocks Non-covered for the Treatment of Diabetic Peripheral Neuropathic Pain.
A56034 Peripheral Nerve Blocks Non-covered for the Treatment of Diabetic Peripheral Neuropathic Pain.
L33933 Peripheral Nerve Blocks.
L35222 Nerve Blocks for Peripheral Neuropathy.
L35249 Nerve Blocks for Peripheral Neuropathy.
L35456 Nerve Blockade for Treatment of Chronic Pain and Neuropathy.
L35457 Nerve Blockade for Treatment of Chronic Pain and Neuropathy.
L36850 Peripheral Nerve Blocks.
L37641 Continuous Peripheral Nerve Blocks (CPNB).
L37642 Nerve Blocks and Electrostimulation for Peripheral Neuropathy.
COMMONLY SUBMITTED CODES:
Codes Code description Comments
62281 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic
62320
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
62321
Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or ct)
62324
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
62325
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or ct)
64402 Injection, anesthetic agent; facial nerve
64405 Injection, anesthetic agent; greater occipital nerve
64408 Injection, anesthetic agent; vagus nerve
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64410 Injection, anesthetic agent; phrenic nerve
64413 Injection, anesthetic agent; cervical plexus
64415 Injection, anesthetic agent; brachial plexus, single
64417 Injection, anesthetic agent; axillary nerve
64418 Injection, anesthetic agent; suprascapular nerve
64420 Injection, anesthetic agent; intercostal nerve, single
64421 Injection, anesthetic agent; intercostal nerves, multiple, regional block
64425 Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves
64430 Injection, anesthetic agent; pudendal nerve
64435 Injection, anesthetic agent; paracervical (uterine) nerve
64445 Injection, anesthetic agent; sciatic nerve, single
64446 Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter (including catheter placement)
64447 Injection, anesthetic agent; femoral nerve, single
64448 Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement)
64449 Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)
64450 Injection, anesthetic agent; other peripheral nerve or branch
64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, morton's neuroma)
64461 Paravertebral block (pvb) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
64462 Paravertebral block (pvb) (paraspinous block), thoracic; second and any additional injection site(s) (includes imaging guidance, when performed) (list separately in addition to code for primary procedure)
64463 Paravertebral block (pvb) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed)
64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or ct); cervical or thoracic, single level
64480 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or ct); cervical or thoracic, each additional level (list separately in addition to code for primary procedure)
64505 Injection, anesthetic agent; sphenopalatine ganglion
64508 Injection, anesthetic agent; carotid sinus (separate procedure)
64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic)
64517 Injection, anesthetic agent; superior hypogastric plexus
64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)
64530 Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring
64620 Destruction by neurolytic agent, intercostal nerve
64632 Destruction by neurolytic agent; plantar common digital nerve
64640 Destruction by neurolytic agent; other peripheral nerve or branch
64450 Injection, anesthetic agent; other peripheral nerve or branch
76881 Ultrasound, extremity, nonvascular, real-time with image documentation; complete
76882 Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
76999 Unlisted ultrasound procedure (eg, diagnostic, interventional)
97032 Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes
97139 Unlisted therapeutic procedure (specify)
B02.0 Zoster encephalitis
B02.1 Zoster meningitis
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B02.21 Postherpetic geniculate ganglionitis
B02.22 Postherpetic trigeminal neuralgia
B02.23 Postherpetic polyneuropathy
B02.24 Postherpetic myelitis
B02.29 Other postherpetic nervous system involvement
B02.7 Disseminated zoster
B02.8 Zoster with other complications
B02.9 Zoster without complications
G50.0 Trigeminal neuralgia
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G54.5 Neuralgic amyotrophy
G54.6 Phantom limb syndrome with pain
G54.8 Other nerve root and plexus disorders
G55 Nerve root and plexus compressions in diseases classified elsewhere
G56.01 Carpal tunnel syndrome, right upper limb
G56.02 Carpal tunnel syndrome, left upper limb
G56.03 Carpal tunnel syndrome, bilateral upper limbs
G56.11 Other lesions of median nerve, right upper limb
G56.12 Other lesions of median nerve, left upper limb
G56.13 Other lesions of median nerve, bilateral upper limbs
G56.21 Lesion of ulnar nerve, right upper limb
G56.22 Lesion of ulnar nerve, left upper limb
G56.23 Lesion of ulnar nerve, bilateral upper limbs
G56.31 Lesion of radial nerve, right upper limb
G56.32 Lesion of radial nerve, left upper limb
G56.33 Lesion of radial nerve, bilateral upper limbs
G56.41 Causalgia of right upper limb
G56.42 Causalgia of left upper limb
G56.43 Causalgia of bilateral upper limbs
G56.81 Other specified mononeuropathies of right upper limb
G56.82 Other specified mononeuropathies of left upper limb
G56.91 Unspecified mononeuropathy of right upper limb
G56.92 Unspecified mononeuropathy of left upper limb
G57.01 Lesion of sciatic nerve, right lower limb
G57.02 Lesion of sciatic nerve, left lower limb
G57.03 Lesion of sciatic nerve, bilateral lower limbs
G57.11 Meralgia paresthetica, right lower limb
G57.12 Meralgia paresthetica, left lower limb
G57.13 Meralgia paresthetica, bilateral lower limbs
G57.21 Lesion of femoral nerve, right lower limb
G57.22 Lesion of femoral nerve, left lower limb
G57.23 Lesion of femoral nerve, bilateral lower limbs
G57.31 Lesion of lateral popliteal nerve, right lower limb
G57.32 Lesion of lateral popliteal nerve, left lower limb
G57.33 Lesion of lateral popliteal nerve, bilateral lower limbs
G57.41 Lesion of medial popliteal nerve, right lower limb
G57.42 Lesion of medial popliteal nerve, left lower limb
G57.43 Lesion of medial popliteal nerve, bilateral lower limbs
G57.51 Tarsal tunnel syndrome, right lower limb
G57.52 Tarsal tunnel syndrome, left lower limb
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G57.53 Tarsal tunnel syndrome, bilateral lower limbs
G57.61* Lesion of plantar nerve, right lower limb
G57.62* Lesion of plantar nerve, left lower limb
G57.63* Lesion of plantar nerve, bilateral lower limbs
G57.71 Causalgia of right lower limb
G57.72 Causalgia of left lower limb
G57.73 Causalgia of bilateral lower limbs
G57.81 Other specified mononeuropathies of right lower limb
G57.82 Other specified mononeuropathies of left lower limb
G57.91* Unspecified mononeuropathy of right lower limb
G57.92* Unspecified mononeuropathy of left lower limb
G58.0 Intercostal neuropathy
G58.7* Mononeuritis multiplex
G58.8* Other specified mononeuropathies
G58.9* Mononeuropathy, unspecified
G59* Mononeuropathy in diseases classified elsewhere
G89.11 Acute pain due to trauma
G89.12 Acute post-thoracotomy pain
G89.18 Other acute postprocedural pain
G89.21 Chronic pain due to trauma
G89.22 Chronic post-thoracotomy pain
G89.28 Other chronic postprocedural pain
G89.3 Neoplasm related pain (acute) (chronic)
G90.50 Complex regional pain syndrome I, unspecified
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.59 Complex regional pain syndrome I of other specified site
I73.00 Raynaud's syndrome without gangrene
I73.01 Raynaud's syndrome with gangrene
L74.510 Primary focal hyperhidrosis, axilla
L74.511 Primary focal hyperhidrosis, face
L74.512 Primary focal hyperhidrosis, palms
L74.513 Primary focal hyperhidrosis, soles
M25.511 Pain in right shoulder
M25.512 Pain in left shoulder
M25.551 Pain in right hip
M25.552 Pain in left hip
M25.561 Pain in right knee
M25.562 Pain in left knee
M43.27 Fusion of spine, lumbosacral region
M43.28 Fusion of spine, sacral and sacrococcygeal region
M46.1 Sacroiliitis, not elsewhere classified
M48.01 Spinal stenosis, occipito-atlanto-axial region
M48.02 Spinal stenosis, cervical region
M48.03 Spinal stenosis, cervicothoracic region
M48.04 Spinal stenosis, thoracic region
M48.05 Spinal stenosis, thoracolumbar region
M48.062 Spinal stenosis, lumbar region with neurogenic claudication
M50.11 Cervical disc disorder with radiculopathy, high cervical region
M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
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M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
M50.13 Cervical disc disorder with radiculopathy, cervicothoracic region
M50.21 Other cervical disc displacement, high cervical region
M50.221 Other cervical disc displacement at C4-C5 level
M50.222 Other cervical disc displacement at C5-C6 level
M50.223 Other cervical disc displacement at C6-C7 level
M50.23 Other cervical disc displacement, cervicothoracic region
M50.31 Other cervical disc degeneration, high cervical region
M50.321 Other cervical disc degeneration at C4-C5 level
M50.322 Other cervical disc degeneration at C5-C6 level
M50.323 Other cervical disc degeneration at C6-C7 level
M50.33 Other cervical disc degeneration, cervicothoracic region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.24 Other intervertebral disc displacement, thoracic region
M51.25 Other intervertebral disc displacement, thoracolumbar region
M51.34 Other intervertebral disc degeneration, thoracic region
M51.35 Other intervertebral disc degeneration, thoracolumbar region
M53.0 Cervicocranial syndrome
M53.2X7 Spinal instabilities, lumbosacral region
M53.2X8 Spinal instabilities, sacral and sacrococcygeal region
M53.3 Sacrococcygeal disorders, not elsewhere classified
M53.81 Other specified dorsopathies, occipito-atlanto-axial region
M53.82 Other specified dorsopathies, cervical region
M53.83 Other specified dorsopathies, cervicothoracic region
M53.86 Other specified dorsopathies, lumbar region
M53.87 Other specified dorsopathies, lumbosacral region
M53.88 Other specified dorsopathies, sacral and sacrococcygeal region
M54.10* Radiculopathy, site unspecified
M54.11 Radiculopathy, occipito-atlanto-axial region
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.2 Cervicalgia
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M54.5 Low back pain
M54.6 Pain in thoracic spine
M54.81 Occipital neuralgia
M79.2* Neuralgia and neuritis, unspecified
M94.0 Chondrocostal junction syndrome [Tietze]
M96.1 Postlaminectomy syndrome, not elsewhere classified
M99.20 Subluxation stenosis of neural canal of head region
M99.21 Subluxation stenosis of neural canal of cervical region
M99.22 Subluxation stenosis of neural canal of thoracic region
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M99.30 Osseous stenosis of neural canal of head region
M99.31 Osseous stenosis of neural canal of cervical region
M99.32 Osseous stenosis of neural canal of thoracic region
M99.40 Connective tissue stenosis of neural canal of head region
M99.41 Connective tissue stenosis of neural canal of cervical region
M99.42 Connective tissue stenosis of neural canal of thoracic region
M99.50 Intervertebral disc stenosis of neural canal of head region
M99.51 Intervertebral disc stenosis of neural canal of cervical region
M99.52 Intervertebral disc stenosis of neural canal of thoracic region
M99.60 Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61 Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.62 Osseous and subluxation stenosis of intervertebral foramina of thoracic region
M99.70 Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71 Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.72 Connective tissue and disc stenosis of intervertebral foramina of thoracic region
R07.1 Chest pain on breathing
R07.81 Pleurodynia
R07.9* Chest pain, unspecified
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R25.0 Abnormal head movements
R25.1 Tremor, unspecified
R25.2 Cramp and spasm
R25.3 Fasciculation
R25.8 Other abnormal involuntary movements
R25.9 Unspecified abnormal involuntary movements
R44.0 Auditory hallucinations
R44.2 Other hallucinations
R44.3 Hallucinations, unspecified
R68.84 Jaw pain
S14.2XXA Injury of nerve root of cervical spine, initial encounter
S14.2XXD Injury of nerve root of cervical spine, subsequent encounter
S14.2XXS Injury of nerve root of cervical spine, sequela
S14.3XXA Injury of brachial plexus, initial encounter
S14.3XXD Injury of brachial plexus, subsequent encounter
S14.3XXS Injury of brachial plexus, sequela
S14.4XXA Injury of peripheral nerves of neck, initial encounter
S14.4XXD Injury of peripheral nerves of neck, subsequent encounter
S14.4XXS Injury of peripheral nerves of neck, sequela
S14.5XXA Injury of cervical sympathetic nerves, initial encounter
S14.5XXD Injury of cervical sympathetic nerves, subsequent encounter
S14.5XXS Injury of cervical sympathetic nerves, sequela
S14.8XXA Injury of other specified nerves of neck, initial encounter
S14.8XXD Injury of other specified nerves of neck, subsequent encounter
S14.8XXS Injury of other specified nerves of neck, sequela
S14.9XXA Injury of unspecified nerves of neck, initial encounter
S14.9XXD Injury of unspecified nerves of neck, subsequent encounter
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S14.9XXS Injury of unspecified nerves of neck, sequela
S24.2XXA Injury of nerve root of thoracic spine, initial encounter
S24.2XXD Injury of nerve root of thoracic spine, subsequent encounter
S24.2XXS Injury of nerve root of thoracic spine, sequela
S24.3XXA Injury of peripheral nerves of thorax, initial encounter
S24.3XXD Injury of peripheral nerves of thorax, subsequent encounter
S24.3XXS Injury of peripheral nerves of thorax, sequela
S24.4XXA Injury of thoracic sympathetic nervous system, initial encounter
S24.4XXD Injury of thoracic sympathetic nervous system, subsequent encounter
S24.4XXS Injury of thoracic sympathetic nervous system, sequela
S24.8XXA Injury of other specified nerves of thorax, initial encounter
S24.8XXD Injury of other specified nerves of thorax, subsequent encounter
S24.8XXS Injury of other specified nerves of thorax, sequela
S24.9XXA Injury of unspecified nerve of thorax, initial encounter
S24.9XXD Injury of unspecified nerve of thorax, subsequent encounter
S24.9XXS Injury of unspecified nerve of thorax, sequela
S34.21XA Injury of nerve root of lumbar spine, initial encounter
S34.21XD Injury of nerve root of lumbar spine, subsequent encounter
S34.21XS Injury of nerve root of lumbar spine, sequela
S34.22XA Injury of nerve root of sacral spine, initial encounter
S34.22XD Injury of nerve root of sacral spine, subsequent encounter
S34.22XS Injury of nerve root of sacral spine, sequela
S34.4XXA Injury of lumbosacral plexus, initial encounter
S34.4XXD Injury of lumbosacral plexus, subsequent encounter
S34.4XXS Injury of lumbosacral plexus, sequela
S34.5XXA Injury of lumbar, sacral and pelvic sympathetic nerves, initial encounter
S34.5XXD Injury of lumbar, sacral and pelvic sympathetic nerves, subsequent encounter
S34.5XXS Injury of lumbar, sacral and pelvic sympathetic nerves, sequela
S34.6XXA Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, initial encounter
S34.6XXD Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, subsequent encounter
S34.6XXS Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, sequela
S34.8XXA Injury of other nerves at abdomen, lower back and pelvis level, initial encounter
S34.8XXD Injury of other nerves at abdomen, lower back and pelvis level, subsequent encounter
S34.8XXS Injury of other nerves at abdomen, lower back and pelvis level, sequela
S34.9XXA Injury of unspecified nerves at abdomen, lower back and pelvis level, initial encounter
S34.9XXD Injury of unspecified nerves at abdomen, lower back and pelvis level, subsequent encounter
S34.9XXS Injury of unspecified nerves at abdomen, lower back and pelvis level, sequela
S44.01XA Injury of ulnar nerve at upper arm level, right arm, initial encounter
S44.01XD Injury of ulnar nerve at upper arm level, right arm, subsequent encounter
S44.01XS Injury of ulnar nerve at upper arm level, right arm, sequela
S44.02XA Injury of ulnar nerve at upper arm level, left arm, initial encounter
S44.02XD Injury of ulnar nerve at upper arm level, left arm, subsequent encounter
S44.02XS Injury of ulnar nerve at upper arm level, left arm, sequela
S44.11XA Injury of median nerve at upper arm level, right arm, initial encounter
S44.11XD Injury of median nerve at upper arm level, right arm, subsequent encounter
S44.11XS Injury of median nerve at upper arm level, right arm, sequela
S44.12XA Injury of median nerve at upper arm level, left arm, initial encounter
S44.12XD Injury of median nerve at upper arm level, left arm, subsequent encounter
S44.12XS Injury of median nerve at upper arm level, left arm, sequela
CORP- CCP.1347 12
S44.21XA Injury of radial nerve at upper arm level, right arm, initial encounter
S44.21XD Injury of radial nerve at upper arm level, right arm, subsequent encounter
S44.21XS Injury of radial nerve at upper arm level, right arm, sequela
S44.22XA Injury of radial nerve at upper arm level, left arm, initial encounter
S44.22XD Injury of radial nerve at upper arm level, left arm, subsequent encounter
S44.22XS Injury of radial nerve at upper arm level, left arm, sequela
S44.30XA Injury of axillary nerve, unspecified arm, initial encounter
S44.30XD Injury of axillary nerve, unspecified arm, subsequent encounter
S44.30XS Injury of axillary nerve, unspecified arm, sequela
S44.31XA Injury of axillary nerve, right arm, initial encounter
S44.31XD Injury of axillary nerve, right arm, subsequent encounter
S44.31XS Injury of axillary nerve, right arm, sequela
S44.32XA Injury of axillary nerve, left arm, initial encounter
S44.32XD Injury of axillary nerve, left arm, subsequent encounter
S44.32XS Injury of axillary nerve, left arm, sequela
S44.41XA Injury of musculocutaneous nerve, right arm, initial encounter
S44.41XD Injury of musculocutaneous nerve, right arm, subsequent encounter
S44.41XS Injury of musculocutaneous nerve, right arm, sequela
S44.42XA Injury of musculocutaneous nerve, left arm, initial encounter
S44.42XD Injury of musculocutaneous nerve, left arm, subsequent encounter
S44.42XS Injury of musculocutaneous nerve, left arm, sequela
S44.51XA Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, initial encounter
S44.51XD Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, subsequent encounter
S44.51XS Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, sequela
S44.52XA Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, initial encounter
S44.52XD Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, subsequent encounter
S44.52XS Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, sequela
S44.8X1A Injury of other nerves at shoulder and upper arm level, right arm, initial encounter
S44.8X1D Injury of other nerves at shoulder and upper arm level, right arm, subsequent encounter
S44.8X1S Injury of other nerves at shoulder and upper arm level, right arm, sequela
S44.8X2A Injury of other nerves at shoulder and upper arm level, left arm, initial encounter
S44.8X2D Injury of other nerves at shoulder and upper arm level, left arm, subsequent encounter
S44.8X2S Injury of other nerves at shoulder and upper arm level, left arm, sequela
S44.91XA Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter
S44.91XD Injury of unspecified nerve at shoulder and upper arm level, right arm, subsequent encounter
S44.91XS Injury of unspecified nerve at shoulder and upper arm level, right arm, sequela
S44.92XA Injury of unspecified nerve at shoulder and upper arm level, left arm, initial encounter
S44.92XD Injury of unspecified nerve at shoulder and upper arm level, left arm, subsequent encounter
S44.92XS Injury of unspecified nerve at shoulder and upper arm level, left arm, sequela
S54.01XA Injury of ulnar nerve at forearm level, right arm, initial encounter
S54.01XD Injury of ulnar nerve at forearm level, right arm, subsequent encounter
S54.01XS Injury of ulnar nerve at forearm level, right arm, sequela
CORP- CCP.1347 13
S54.02XA Injury of ulnar nerve at forearm level, left arm, initial encounter
S54.02XD Injury of ulnar nerve at forearm level, left arm, subsequent encounter
S54.02XS Injury of ulnar nerve at forearm level, left arm, sequela
S54.11XA Injury of median nerve at forearm level, right arm, initial encounter
S54.11XD Injury of median nerve at forearm level, right arm, subsequent encounter
S54.11XS Injury of median nerve at forearm level, right arm, sequela
S54.12XA Injury of median nerve at forearm level, left arm, initial encounter
S54.12XD Injury of median nerve at forearm level, left arm, subsequent encounter
S54.12XS Injury of median nerve at forearm level, left arm, sequela
S54.21XA Injury of radial nerve at forearm level, right arm, initial encounter
S54.21XD Injury of radial nerve at forearm level, right arm, subsequent encounter
S54.21XS Injury of radial nerve at forearm level, right arm, sequela
S54.22XA Injury of radial nerve at forearm level, left arm, initial encounter
S54.22XD Injury of radial nerve at forearm level, left arm, subsequent encounter
S54.22XS Injury of radial nerve at forearm level, left arm, sequela
S54.31XA Injury of cutaneous sensory nerve at forearm level, right arm, initial encounter
S54.31XD Injury of cutaneous sensory nerve at forearm level, right arm, subsequent encounter
S54.31XS Injury of cutaneous sensory nerve at forearm level, right arm, sequela
S54.32XA Injury of cutaneous sensory nerve at forearm level, left arm, initial encounter
S54.32XD Injury of cutaneous sensory nerve at forearm level, left arm, subsequent encounter
S54.32XS Injury of cutaneous sensory nerve at forearm level, left arm, sequela
S54.8X1A Injury of other nerves at forearm level, right arm, initial encounter
S54.8X1D Injury of other nerves at forearm level, right arm, subsequent encounter
S54.8X1S Injury of other nerves at forearm level, right arm, sequela
S54.8X2A Injury of other nerves at forearm level, left arm, initial encounter
S54.8X2D Injury of other nerves at forearm level, left arm, subsequent encounter
S54.8X2S Injury of other nerves at forearm level, left arm, sequela
S54.91XA Injury of unspecified nerve at forearm level, right arm, initial encounter
S54.91XD Injury of unspecified nerve at forearm level, right arm, subsequent encounter
S54.91XS Injury of unspecified nerve at forearm level, right arm, sequela
S54.92XA Injury of unspecified nerve at forearm level, left arm, initial encounter
S54.92XD Injury of unspecified nerve at forearm level, left arm, subsequent encounter
S54.92XS Injury of unspecified nerve at forearm level, left arm, sequela
S64.01XA Injury of ulnar nerve at wrist and hand level of right arm, initial encounter
S64.01XD Injury of ulnar nerve at wrist and hand level of right arm, subsequent encounter
S64.01XS Injury of ulnar nerve at wrist and hand level of right arm, sequela
S64.02XA Injury of ulnar nerve at wrist and hand level of left arm, initial encounter
S64.02XD Injury of ulnar nerve at wrist and hand level of left arm, subsequent encounter
S64.02XS Injury of ulnar nerve at wrist and hand level of left arm, sequela
S64.11XA Injury of median nerve at wrist and hand level of right arm, initial encounter
S64.11XD Injury of median nerve at wrist and hand level of right arm, subsequent encounter
S64.11XS Injury of median nerve at wrist and hand level of right arm, sequela
S64.12XA Injury of median nerve at wrist and hand level of left arm, initial encounter
S64.12XD Injury of median nerve at wrist and hand level of left arm, subsequent encounter
S64.12XS Injury of median nerve at wrist and hand level of left arm, sequela
S64.21XA Injury of radial nerve at wrist and hand level of right arm, initial encounter
S64.21XD Injury of radial nerve at wrist and hand level of right arm, subsequent encounter
S64.21XS Injury of radial nerve at wrist and hand level of right arm, sequela
S64.22XA Injury of radial nerve at wrist and hand level of left arm, initial encounter
S64.22XD Injury of radial nerve at wrist and hand level of left arm, subsequent encounter
S64.22XS Injury of radial nerve at wrist and hand level of left arm, sequela
S64.31XA Injury of digital nerve of right thumb, initial encounter
S64.31XD Injury of digital nerve of right thumb, subsequent encounter
CORP- CCP.1347 14
S64.31XS Injury of digital nerve of right thumb, sequela
S64.32XA Injury of digital nerve of left thumb, initial encounter
S64.32XD Injury of digital nerve of left thumb, subsequent encounter
S64.32XS Injury of digital nerve of left thumb, sequela
S64.490A Injury of digital nerve of right index finger, initial encounter
S64.490D Injury of digital nerve of right index finger, subsequent encounter
S64.490S Injury of digital nerve of right index finger, sequela
S64.491A Injury of digital nerve of left index finger, initial encounter
S64.491D Injury of digital nerve of left index finger, subsequent encounter
S64.491S Injury of digital nerve of left index finger, sequela
S64.492A Injury of digital nerve of right middle finger, initial encounter
S64.492D Injury of digital nerve of right middle finger, subsequent encounter
S64.492S Injury of digital nerve of right middle finger, sequela
S64.493A Injury of digital nerve of left middle finger, initial encounter
S64.493D Injury of digital nerve of left middle finger, subsequent encounter
S64.493S Injury of digital nerve of left middle finger, sequela
S64.494A Injury of digital nerve of right ring finger, initial encounter
S64.494D Injury of digital nerve of right ring finger, subsequent encounter
S64.494S Injury of digital nerve of right ring finger, sequela
S64.495A Injury of digital nerve of left ring finger, initial encounter
S64.495D Injury of digital nerve of left ring finger, subsequent encounter
S64.495S Injury of digital nerve of left ring finger, sequela
S64.496A Injury of digital nerve of right little finger, initial encounter
S64.496D Injury of digital nerve of right little finger, subsequent encounter
S64.496S Injury of digital nerve of right little finger, sequela
S64.497A Injury of digital nerve of left little finger, initial encounter
S64.497D Injury of digital nerve of left little finger, subsequent encounter
S64.497S Injury of digital nerve of left little finger, sequela
S64.498A Injury of digital nerve of other finger, initial encounter
S64.498D Injury of digital nerve of other finger, subsequent encounter
S64.498S Injury of digital nerve of other finger, sequela
S64.8X1A Injury of other nerves at wrist and hand level of right arm, initial encounter
S64.8X1D Injury of other nerves at wrist and hand level of right arm, subsequent encounter
S64.8X1S Injury of other nerves at wrist and hand level of right arm, sequela
S64.8X2A Injury of other nerves at wrist and hand level of left arm, initial encounter
S64.8X2D Injury of other nerves at wrist and hand level of left arm, subsequent encounter
S64.8X2S Injury of other nerves at wrist and hand level of left arm, sequela
S64.91XA Injury of unspecified nerve at wrist and hand level of right arm, initial encounter
S64.91XD Injury of unspecified nerve at wrist and hand level of right arm, subsequent encounter
S64.91XS Injury of unspecified nerve at wrist and hand level of right arm, sequela
S64.92XA Injury of unspecified nerve at wrist and hand level of left arm, initial encounter
S64.92XD Injury of unspecified nerve at wrist and hand level of left arm, subsequent encounter
S64.92XS Injury of unspecified nerve at wrist and hand level of left arm, sequela
S74.01XA Injury of sciatic nerve at hip and thigh level, right leg, initial encounter
S74.01XD Injury of sciatic nerve at hip and thigh level, right leg, subsequent encounter
S74.01XS Injury of sciatic nerve at hip and thigh level, right leg, sequela
S74.02XA Injury of sciatic nerve at hip and thigh level, left leg, initial encounter
S74.02XD Injury of sciatic nerve at hip and thigh level, left leg, subsequent encounter
S74.02XS Injury of sciatic nerve at hip and thigh level, left leg, sequela
S74.11XA Injury of femoral nerve at hip and thigh level, right leg, initial encounter
S74.11XD Injury of femoral nerve at hip and thigh level, right leg, subsequent encounter
S74.11XS Injury of femoral nerve at hip and thigh level, right leg, sequela
S74.12XA Injury of femoral nerve at hip and thigh level, left leg, initial encounter
CORP- CCP.1347 15
S74.12XD Injury of femoral nerve at hip and thigh level, left leg, subsequent encounter
S74.12XS Injury of femoral nerve at hip and thigh level, left leg, sequela
S74.21XA Injury of cutaneous sensory nerve at hip and high level, right leg, initial encounter
S74.21XD Injury of cutaneous sensory nerve at hip and high level, right leg, subsequent encounter
S74.21XS Injury of cutaneous sensory nerve at hip and high level, right leg, sequela
S74.22XA Injury of cutaneous sensory nerve at hip and thigh level, left leg, initial encounter
S74.22XD Injury of cutaneous sensory nerve at hip and thigh level, left leg, subsequent encounter
S74.22XS Injury of cutaneous sensory nerve at hip and thigh level, left leg, sequela
S74.8X1A Injury of other nerves at hip and thigh level, right leg, initial encounter
S74.8X1D Injury of other nerves at hip and thigh level, right leg, subsequent encounter
S74.8X1S Injury of other nerves at hip and thigh level, right leg, sequela
S74.8X2A Injury of other nerves at hip and thigh level, left leg, initial encounter
S74.8X2D Injury of other nerves at hip and thigh level, left leg, subsequent encounter
S74.8X2S Injury of other nerves at hip and thigh level, left leg, sequela
S74.91XA Injury of unspecified nerve at hip and thigh level, right leg, initial encounter
S74.91XD Injury of unspecified nerve at hip and thigh level, right leg, subsequent encounter
S74.91XS Injury of unspecified nerve at hip and thigh level, right leg, sequela
S74.92XA Injury of unspecified nerve at hip and thigh level, left leg, initial encounter
S74.92XD Injury of unspecified nerve at hip and thigh level, left leg, subsequent encounter
S74.92XS Injury of unspecified nerve at hip and thigh level, left leg, sequela
S84.01XA Injury of tibial nerve at lower leg level, right leg, initial encounter
S84.01XD Injury of tibial nerve at lower leg level, right leg, subsequent encounter
S84.01XS Injury of tibial nerve at lower leg level, right leg, sequela
S84.02XA Injury of tibial nerve at lower leg level, left leg, initial encounter
S84.02XD Injury of tibial nerve at lower leg level, left leg, subsequent encounter
S84.02XS Injury of tibial nerve at lower leg level, left leg, sequela
S84.11XA Injury of peroneal nerve at lower leg level, right leg, initial encounter
S84.11XD Injury of peroneal nerve at lower leg level, right leg, subsequent encounter
S84.11XS Injury of peroneal nerve at lower leg level, right leg, sequela
S84.12XA Injury of peroneal nerve at lower leg level, left leg, initial encounter
S84.12XD Injury of peroneal nerve at lower leg level, left leg, subsequent encounter
S84.12XS Injury of peroneal nerve at lower leg level, left leg, sequela
S84.21XA Injury of cutaneous sensory nerve at lower leg level, right leg, initial encounter
S84.21XD Injury of cutaneous sensory nerve at lower leg level, right leg, subsequent encounter
S84.21XS Injury of cutaneous sensory nerve at lower leg level, right leg, sequela
S84.22XA Injury of cutaneous sensory nerve at lower leg level, left leg, initial encounter
S84.22XD Injury of cutaneous sensory nerve at lower leg level, left leg, subsequent encounter
S84.22XS Injury of cutaneous sensory nerve at lower leg level, left leg, sequela
S84.801A Injury of other nerves at lower leg level, right leg, initial encounter
S84.801D Injury of other nerves at lower leg level, right leg, subsequent encounter
S84.801S Injury of other nerves at lower leg level, right leg, sequela
S84.802A Injury of other nerves at lower leg level, left leg, initial encounter
S84.802D Injury of other nerves at lower leg level, left leg, subsequent encounter
S84.802S Injury of other nerves at lower leg level, left leg, sequela
S84.91XA Injury of unspecified nerve at lower leg level, right leg, initial encounter
S84.91XD Injury of unspecified nerve at lower leg level, right leg, subsequent encounter
S84.91XS Injury of unspecified nerve at lower leg level, right leg, sequela
S84.92XA Injury of unspecified nerve at lower leg level, left leg, initial encounter
S84.92XD Injury of unspecified nerve at lower leg level, left leg, subsequent encounter
S84.92XS Injury of unspecified nerve at lower leg level, left leg, sequela
S94.01XA Injury of lateral plantar nerve, right leg, initial encounter
CORP- CCP.1347 16
S94.01XD Injury of lateral plantar nerve, right leg, subsequent encounter
S94.01XS Injury of lateral plantar nerve, right leg, sequela
S94.02XA Injury of lateral plantar nerve, left leg, initial encounter
S94.02XD Injury of lateral plantar nerve, left leg, subsequent encounter
S94.02XS Injury of lateral plantar nerve, left leg, sequela
S94.11XA Injury of medial plantar nerve, right leg, initial encounter
S94.11XD Injury of medial plantar nerve, right leg, subsequent encounter
S94.11XS Injury of medial plantar nerve, right leg, sequela
S94.12XA Injury of medial plantar nerve, left leg, initial encounter
S94.12XD Injury of medial plantar nerve, left leg, subsequent encounter
S94.12XS Injury of medial plantar nerve, left leg, sequela
S94.21XA Injury of deep peroneal nerve at ankle and foot level, right leg, initial encounter
S94.21XD Injury of deep peroneal nerve at ankle and foot level, right leg, subsequent encounter
S94.21XS Injury of deep peroneal nerve at ankle and foot level, right leg, sequela
S94.22XA Injury of deep peroneal nerve at ankle and foot level, left leg, initial encounter
S94.22XD Injury of deep peroneal nerve at ankle and foot level, left leg, subsequent encounter
S94.22XS Injury of deep peroneal nerve at ankle and foot level, left leg, sequela
S94.31XA Injury of cutaneous sensory nerve at ankle and foot level, right leg, initial encounter
S94.31XD Injury of cutaneous sensory nerve at ankle and foot level, right leg, subsequent encounter
S94.31XS Injury of cutaneous sensory nerve at ankle and foot level, right leg, sequela
S94.32XA Injury of cutaneous sensory nerve at ankle and foot level, left leg, initial encounter
S94.32XD Injury of cutaneous sensory nerve at ankle and foot level, left leg, subsequent encounter
S94.32XS Injury of cutaneous sensory nerve at ankle and foot level, left leg, sequela
S94.8X1A Injury of other nerves at ankle and foot level, right leg, initial encounter
S94.8X1D Injury of other nerves at ankle and foot level, right leg, subsequent encounter
S94.8X1S Injury of other nerves at ankle and foot level, right leg, sequela
S94.8X2A Injury of other nerves at ankle and foot level, left leg, initial encounter
S94.8X2D Injury of other nerves at ankle and foot level, left leg, subsequent encounter
S94.8X2S Injury of other nerves at ankle and foot level, left leg, sequela
S94.91XA Injury of unspecified nerve at ankle and foot level, right leg, initial encounter
S94.91XD Injury of unspecified nerve at ankle and foot level, right leg, subsequent encounter
S94.91XS Injury of unspecified nerve at ankle and foot level, right leg, sequela
S94.92XA Injury of unspecified nerve at ankle and foot level, left leg, initial encounter
S94.92XD Injury of unspecified nerve at ankle and foot level, left leg, subsequent encounter
POLICY UPDATES:
Date Researcher Update
April 2, 2019 E. Adams No new information. No policy changes.
October 19, 2017 E. Adams Initial policy.
REFERENCES:
On August 31, 2018, we searched PubMed and the databases of the U.K. National Health Services Centre for Reviews
and Dissemination, Agency for Healthcare Research and Quality, and Centers for Medicare & Medicaid Services. Search
terms were: “Nerve block/methods (MeSH),” “Chronic pain (MeSH),” and free text terms “continuous peripheral nerve
block” and “perineural infusion.” We included the best available evidence according to established evidence hierarchies
CORP- CCP.1347 17
(typically systematic reviews, meta-analyses, and full economic analyses, where available) and professional guidelines
based on such evidence and clinical expertise.
Aguirre J, Del Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiol Res
Pract. 2012;2012:560879. Doi: 10.1155/2012/560879.
American Society of Anesthesiologists Task Force on Chronic Pain Management and American Society of Regional
Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American
Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia
and Pain Medicine. Anesthesiology. 2010;112(4):810-833. Doi: 10.1097/ALN.0b013e3181c43103.
Arcidiacono PG, Calori G, Carrara S, McNicol ED, Testoni PA. Celiac plexus block for pancreatic cancer pain in adults.
Cochrane Database Syst Rev. 2011;(3):Cd007519. Doi: 10.1002/14651858.CD007519.pub2.
Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. Vital
Health Stat 2014;10(260). National Center for Health Statistics website.
https://www.cdc.gov/nchs/data/series/sr_10/sr10_260.pdf. Published 2014. Accessed February 12, 2019.
Bingham AE, Fu R, Horn JL, Abrahams MS. Continuous peripheral nerve block compared with single-injection peripheral
nerve block: a systematic review and meta-analysis of randomized controlled trials. Reg Anesth Pain Med.
2012;37(6):583-594. Doi: 10.1097/AAP.0b013e31826c351b.
Blumenfeld A, Ashkenazi A, Napchan U, et al. Expert consensus recommendations for the performance of peripheral
nerve blocks for headaches--a narrative review. Headache. 2013;53(3):437-446. Doi: 10.1111/head.12053.
Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic
therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (third edition). Reg
Anesth Pain Med. 2010;35(1):64-101. Doi: 10.1097/AAP.0b013e3181c15c70.
Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113(4):904-925.
Doi: 10.1213/ANE.0b013e3182285e01.
Ilfeld BM. Continuous peripheral nerve blocks: an update of the published evidence and comparison with novel,
alternative analgesic modalities. Anesth Analg. 2017;124(1):308-335. Doi: 10.1213/ane.0000000000001581.
Institute of Medicine. Committee on Advancing Pain Research, Care, and Education. Relieving pain in America: A
blueprint for transforming prevention, care, education, and research. National Academies Press website. www.nap.edu.
Published 2011. Accessed February 12, 2019.
Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional
techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16(2 Suppl):S49-283.
http://www.painphysicianjournal.com/linkout?issn=1533-3159&vol=16&page=S49. Accessed February 12, 2019.
CORP- CCP.1347 18
Martelletti P, Jensen RH, Antal A, et al. Neuromodulation of chronic headaches: position statement from the European
Headache Federation. J Headache Pain. 2013;14:86. Doi: 10.1186/1129-2377-14-86.
National Academies of Sciences, Engineering, and Medicine. Pain management and the opioid epidemic: Balancing
societal and individual benefits and risks of prescription opioid use. National Academies Press website.
https://www.nap.edu/catalog/24781/pain-management-and-the-opioid-epidemic-balancing-societal-and-individual.
Published 2017. Accessed February 12, 2019.
National Comprehensive Cancer Network Guidelines Version 1.2019. Adult cancer pain. www.nccn.org. Published
January 25, 2019. Accessed February 12, 2019 .
Neal JM, Barrington MJ, Brull R, et al. The second ASRA practice advisory on neurologic complications associated with
regional anesthesia and pain medicine: Executive summary 2015. Reg Anesth Pain Med. 2015;40(5):401-430. Doi:
10.1097/AAP.0000000000000286.
Paice JA, Portenoy R, Lacchetti C, et al. Management of chronic pain in survivors of adult cancers: American Society of
Clinical Oncology clinical practice guideline. Journal of Clinical Oncology. 2016;34(27):3325-3345. Doi:
10.1200/jco.2016.68.5206.
Pleis JR WB, Lucas JW. Summary health statistics for U.S. adults: National Health Interview Survey, 2009. National Center
for Health Statistics. Vital Health Stat. 2010;10(249). Centers for Disease Control and Prevention website.
https://www.cdc.gov/nchs/data/series/sr_10/sr10_249.pdf. Published 2010. Accessed August 31, 2018.
APPENDIX:
No additional information was identified for this section during the writing of this policy.