# L5 transverse process and iliac pseudoarthrosis injection



## themaid174@gmail.com (Apr 2, 2015)

This is a new one to me. Can anyone help me out?


Patient in prone position with a pillow under the abdomen. Significantly elongated transverse processes were noted throughout the lumbar region including on the left side at the L5 level with close proximity to the left iliac crest with motion. The site of his pain was identified coinciding with this site and a 22-gauge, 3 1/2 inch spinal needle with a slighty curved tip was advanced into the junction between these two landmarks and after negative aspiration for air, blood or CSF, a total of 2mL of 1% lidocane and 40 mg of Kenalog in 1 mL were injected in a fanwise fashion through this region.

Thank you!


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## pclaybaugh (Apr 2, 2015)

Could you look at CPT 64475 (_Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level_) or *CPT 64999 *(_Unlisted procedure,_ _nervous system_).


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## dwaldman (Apr 2, 2015)

Here an example from AMA CPT Assistant of a similar region and like Patricia stated 64475/64493 or potentially  what is being described in your post falls under CPT 64999.

February 2011 page 8

Surgery: Nervous System, 64493 (Q&A) 

Question: What CPT code is reported for a diagnostic right L5 pars injection using fluoroscopy? The patient was treated for low back pain and was under evaluation by a neurosurgeon for possible surgical intervention. The neurosurgeon requested a right L5 pars diagnostic injection to help determine pain generator. "Pars" refers to a part or portion of the anatomical structure, the spine in this case. Utilizing AP fluoroscopy, the right L5 pars was identified and a 20-gauge spinal needle was directed down to it. After careful aspiration, 0.5 cc of a 50/50 combination of 0.5% marcaine and 1% lidocaine without epinephrine were injected. 

Answer: CPT code 64493, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level, is reported for injection of a diagnostic agent into the paravertebral facet joint using fluoroscopic guidance.


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