# facet cyst rupture and ESI injection



## amrcpc (Feb 24, 2015)

ESI and Facet joint injection/cyst rupture was all performed on the same  level(L4-5)- what is the appropriate code(s)

Thank you in advance

report
Exam: Left L4-5 lumbar facet injection/rupture, Lumbar intralaminarESI

CPT code: 64493, 62311, 77003

History: Patient has the history of low back pain and facet arthropathy, left L4-5 synovial cyst producing spinal canal stenosis.

Technique: Informed consent was obtained.  Patient was placed prone on the angiography table.  Using usual sterile technique, lidocaine local anesthesia and fluoroscopic guidance, a 22-gauge needle was inserted into the leftL4-5 facet joint. 1 cc of 
amber fluid was aspirated.  1 cc of Omnipaque 180 contrast was injected to opacify the cyst. Injection was then performed with a 3 cc mixture of methylprednisolone 20mg with lidocaine 1% 1.0  cc and normal saline 1.5  cc.  After 2 cc was injected, there 
is considerable pressure build up followed by release of pressure as the cyst ruptured.  Patient tolerated this well and there were no complications.

Next, lumbar epidural steroid injection was performed at L4-5 via midline approach is no loss of resistance technique was saline.  Injection of the posterior epidural space was performed with methylprednisolone 20mg mixed with normal saline 1 cc and 
bupivacaine .25% 1 cc.

Radiation dose was 1000 cGycm2.   Images and report were permanently recorded.


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