CPT® Code 64425

The CPT® Code 64425 refers to the injection of anesthetic agents and/or steroids targeting the ilioinguinal and iliohypogastric nerves. This procedure, commonly known as a nerve block, serves both diagnostic and therapeutic purposes. The ilioinguinal and iliohypogastric nerves originate from the first lumbar vertebra (L1) and are crucial for providing sensory innervation to the skin in the lower abdominal region. These nerves emerge from the upper lateral border of the psoas major muscle and subsequently penetrate the transversus abdominus muscle, located just above and medial to the anterior superior iliac spine. As the nerves travel, they run between the transversus abdominus and internal oblique muscles for a brief distance before they penetrate the internal oblique. They continue their path between the internal and external oblique muscles, ultimately branching out and penetrating the external oblique muscle, where they provide sensory innervation to the skin. The procedure involves careful identification of the anterior superior iliac spine, marking the planned injection site, which is positioned medial and superior to this landmark. The injection technique requires precise needle placement, starting with a perpendicular insertion through the skin, followed by advancement through the external oblique muscle into the intermuscular space between the internal and external oblique muscles. Aspiration is performed to confirm that the needle is not within a blood vessel before the anesthetic agent and/or steroid is injected. The procedure may be repeated by advancing the needle through the internal oblique muscle into the space between the internal oblique and transversus abdominus, ensuring proper placement and aspiration before injection. This detailed approach is essential for achieving effective pain relief and diagnostic outcomes.