# Bilateral L3 through S1 medial branch injections



## coderguy1939 (Sep 29, 2008)

Doctor did bilateral medial branch injections "at L3, L4, L5 and S1".  Would this be coded for three levels 64475-50, 64476-50 & 64476-50 or four levels 64475-50, 64476-50, 64476-50 & 64476-50?  Input would be appreciated.


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## dmaec (Sep 29, 2008)

depends - i see two levels bilateral 
between L3/L4 -64475.50
and L5/S1 - 64476.50

how many bilateral level "injections" did the doctor do? 2, 3, or as you suggest is possible - 4?  That's the key to how many different levels the doc did - depends where it was placed - and documentation should state clearly how many "times", and how many "different" levels...

_{that's my opinion on the posted matter}_


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## coderguy1939 (Sep 29, 2008)

Op rpt states "injected at each of the levels at right L3, L4, L5, right sacral ala and right S1".  The description for the left side injections reads the same.


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## mbort (Sep 29, 2008)

I see three levels bilaterally.
L3-L4  64475-50
L4-L5  64476-50
L5-S1  64476-59-50



Mary


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## dmaec (Sep 29, 2008)

given the added info - I agree with Mary - 3 levels... (not 2 and not 4)


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## KimberlyLanier (Sep 30, 2008)

*Bier Block*

I am doing Pain Management Coding and the Dr. Operative Report states that he did a Bier Block.

The right upper extremity was exsangiuinated with an esmarch and the dual tournigquet was inflated.  Then 45ml of volume containing 9 ml of labetalo and 36 ml of 0.5 preservaticve free lidocaine was injected into the right upper extremity ulitlizing previously placed 22 gauge hep-lock that was place in the hand it remained in place for 35 minutes while pt sedated.  the cuff was intermittently delated and re-inflated over the next three minutes. 

Could someone tell me what procedure code to use for this procedure, first time ever having one done as Pain Management.

Thanks
Kim


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## jdrueppel (Oct 3, 2008)

Unfortunately the correct code BIER BLOCK is the unlisted CPT 64999.  CPT eliminated the specified anesthesia code for this procedure (I think it was 01995) a couple years ago.

Julie Drueppel, CPC


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## KimberlyLanier (Oct 6, 2008)

*Julie*

Thanks so much for the reply and the help on this Bier Block.  I just started coding Pain Management so I need all the help I can get.

Kimberly


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