# Left L5, S1, S2, S3 Nerve Block



## sharonvalwa (May 14, 2012)

Can someone assist? 

Note: 

Procedure: Left L5, S1, S2, S3 Nerve Block

The left L5, S1, S2, S3 nerves were identified under fluoroguidance in the oblique view. the area was prepped and draped in surgical fashion. Then a skin wheel was made with 3cc of Lidocaine 1% using 25 gauge needle for each level. A 22 gauge spinal needle 3.5 inches was advanced into each facet joint under fluoroguidance with negative aspitation to blood, CSF, or parathesia. The nerves were injected with 40mg Depomedrol and Marcaine .25% after repeated negative aspiration to blood, CSF, or parathesia. 
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I believe this is 4 levels, however, I am not sure if a facets joint injection or medial branch nerve block was performed?


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## jmcpolin (May 14, 2012)

The needle was placed in the facet joint I would code Facet injections


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## dwaldman (May 14, 2012)

was advanced into each facet joint under fluoroguidance with negative aspitation to blood, CSF, or parathesia. The nerves were injected with 40mg Depomedrol and Marcaine .25% after repeated negative aspiration to blood, CSF, or parathesia. 
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I would review with the physician what was performed. There is a concern about the fact the procedure note says "....was advanced into each facet joint" but there is description of S1, S2, S3 which these nerves would typically not be associated with a facet joint level. I would review with the physician if the blocking of S1, S2, S3 was the lateral branches that innervate the sacroilliac joint and the corresponding non-neurolytic code would be 64450 per nerve blocked. Was the L5 block for innervation of the L5-S1 facet joint or was this a lateral branch contributing to the SI Joint. 

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Below is from CPT Assistant

Procedurally, the work of the described SI joint destruction differs from that described by code 64622, Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level. Code 64622 may be reported for L5-S1 rhizotomy (nerve destruction since this joint lies between two spinal segments for which the anatomy and procedural work at L5-S1 is similar to that at other spinal segments (eg, L4-5). Therefore, the unlisted nervous system code 64999 would be reported once for SI joint or sacral rhizotomy (nerve destruction). 

To differentiate between the work when performing sacral nerve destruction of S1, S2, S3, and S4, each individually separate peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by by neurolytic agent; other peripheral nerve or branch. In this instance, code 64640 is reported four times. It is suggested that Modifier 59, Distinct Procedural Service, be appended as well.


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## sharonvalwa (May 15, 2012)

Thank you for the information; I am reviewing records, and this one stumped me, as they billed DX 846.0 and 64493x1 unit.


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