# new to interventional pain procedures



## Rita Bartholomew (Oct 3, 2013)

Provider gives us 64493, 64450x3 for the following note.  Are these codes correct?  Is it okay to use both of these codes?

PROCEDURE: medial branch block injection (rt L5 medial branch block and rt S1-S3 lateral nerve block w/fluoroscopy), selective nerve root block (rt S1-3 lateral branch block).

Level: L5 MBB/Right S1-S3 lateral branch selective nerve block
Spinal needle: 3.5 25 gauge
Fluoroscopic guidance used confirmation of correct needle placement attained.
Medication injected:  Triamcinolone 80mg and Ropivicaine 0.2% (bupivicaine .25%)


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## dwaldman (Oct 7, 2013)

It appears the codes they are supplying are correct, if for S1,S2,S3 lateral branches that innervate the sacroiliac joint were individually blocked for 64450 (S1), 64450 (S2), 64450 (S3).  For L5 MBB, is this for innervation to the L5-S1 facet joint or blocked in a way for innervation to the SI Joint. That might need to be reviewed to confirm 64493 versus L5 lateral branch with 64450.


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## dwaldman (Oct 7, 2013)

http://www.denverbackpainspecialists.com/sacroiliac-joint-rf-ablation-l5dr-s1-3-lb/

The above link has an overview of studies. Although it is for radiofrequency ablation, it still points out they have the same target areas as the non-neurolytic procedure you are presenting. lateral branches S1-S3 and L5 dorsal ramus. But it does seem that they are blocking L5 dorsal ramus for contribution to the SI joint is how I am interpreting it and if that is so that raises the question if you should be using 64493 which although the descriptor states or the nerves that innervate the joint, in this scenario it seems like might be treatment for SIJ instead of facet and potentially not the intention of code??? Not sure but it does seem different than L2-L5 or L3-L5 facet medial branch block in terms of using the facet code 64493 when it is for different type of procedure.


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