# Pain Management question on documentation



## r.e.christie (Jul 24, 2010)

I am fairly new to Pain Management.  I am trying to find out if when a physician documents joints and nerves, if there are specific ways that they are required to document these areas..EX:  Joints would be documented as 
L3/L4  L4/L5  Nerves would be documented as L2, L3, L4.  Does is matter if (/) and (,) are used?  Or is that what seperates a joint from a nerve?


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## vakulabhushan (Jul 25, 2010)

Pain in joints is specified by location. For example knee, elbow or spine (cervical, thoracic, thoracolumbar, lumbar, lumbosacral or sacral). 

If intervertebral discs are involved physicians describe the location by indicating the vertebra by L4/L5 if disc between 4th and 5th lumbar vertebrae are involved or L5/S1 if disc between 5th lumbar and 1st sacral vertebrae are affected.

Pain due to neuropathy (Nerves) can be described by specific nerves or by the nerve root which innervates a particular area. L2,L3,L4 indicates that there is lesion in the L2,L3,L4 nerve roots causing pain.


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## dwaldman (Jul 26, 2010)

L3/L4 L4/L5 Nerves would be documented as L2, L3, L4. 

If the physician is doing a medial branch block he might only list the medial branch nerves he targeted. Using the concept that L2,L3 innervate L3/L4 and L3,L4 innervate L4/L5 you know you have 64493 64494. Two of the physician's that are in the group I work for will say Medial branch block of L2, L3, L4 which correspond with L3/L4 and L4/L5. This can be helpful that everyone is on the same page. I have seen where it has been pointed out by another forum member that with Medial branch blocks you have make sure that L2,L3,L4 refers to nerves and not the anatomical location of each the injections. Going over a couple notes with the physicians to clarify this can add confidence that you do not over or under code the amount of levels treated.


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## r.e.christie (Jul 27, 2010)

Thank you for the help.  I have 27 physicians and not all of them agree, or do the documentation the same way, which makes it even more confusing.  Any help or advice, is much appreciated!  I have over 15 years experience in the medical field, first time in Pain Management.  Would love to network with others.


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