# MNBB and Dorsal ramus injections



## nan.coder (Jun 7, 2011)

Our doctor wants to bill for L4-5 median nerve branch block as well as for a L5 dorsal ramus procedure.  Can both 64493 and 64494 be billed with these levels?


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## dwaldman (Jun 8, 2011)

Below CPT Assistant references would support two facet levels in the lumbar region represented by 64493 as described by the L3,L4 medial branches that innervate the L4-L5 facet joint and 64494 for the L4 medial branch and L5 dorsal ramus innervating the L5-S1 facet joint.



August 2010 CPT ASSISTANT

The L3, L4, and L5 medial branch nerves innervate the L4-L5 and L5-S1 facet joints. Therefore, code 64493,Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level,is reported for the first joint injected or blocked (L4-L5). Code 64493 is reported for a single or initial level treated. Add-on code 64494,Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral;second level (List separately in addition to code for primary procedure),is reported for the second joint or level injected or blocked (L5-S1).

Additionally from September 2004 CPT ASSISTANT

"It should be further emphasized that codes 64475, 64476, 64479, and 64480 refer to the injection of a facet joint either by injection into the joint with one needle puncture or by anesthetizing the two medial branch nerves that supply each joint (two needle punctures). For example, a left-sided L4-L5 intra-articular injection performed with a single needle puncture would be coded as 64475. Injection of the L3 and L4 medial branch nerves supplying the L4-L5 facet joint would also be coded as 64475, even though two separate injections are performed to effect the same result."


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