# Posterior Tibial & Left Saphenous Nerve Block



## lcole7465 (May 24, 2018)

So, in the office setting, my pain management doctor performed a Left Posterior Tibial Nerve Block and a Left Saphenous Nerve Block during the same session under U/S Guidance. I'm billing 64450-LT; 64450-51-LT, 76942.


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## dwaldman (May 31, 2018)

Below is from a great site that describes the anatomy and performance of the mentioned nerve blocks. I agree with your code selection as long as two separate needle placement targeting two separate nerves with proper documentation of ultrasound guidance is in the note.

https://www.nysora.com/ankle-block

Tibial Nerve

The tibial nerve separates from the common popliteal nerve proximal to the popliteal fossa crease and joins the tibial artery behind the knee joint. The nerve runs distally in the thick neurovascular fascia and emerges at the inferior third of the leg from beneath the soleus and gastrocnemius muscles on the medial border of the Achilles tendon (Figure 5). At the level of the medial malleolus, the tibial nerve is covered by the superficial and deep fasciae of the leg. It is positioned laterally and posteriorly to the posterior tibial artery and midway between the posterior aspect of the medial malleolus and the posterior aspect of the Achilles tendon. Just beneath the malleolus, the nerve divides into lateral and medial plantar nerves. The posterior tibial nerve provides cutaneous, articular, and vascular branches to the ankle joint, medial malleolus, inner aspect of the heel, and Achilles tendon. It also branches to the skin, subcutaneous tissue, muscles, and bones of the sole.

Saphenous Nerve

The saphenous nerve is a terminal cutaneous branch (or branches) of the femoral nerve. Its course is in the subcutaneous tissue of the skin on the medial aspect of the ankle and foot


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