# SI joint injection and L5 Dorsal Ramus Inj



## AR2728 (Jan 16, 2013)

I'm so lost on pain coding-so very lost.  Any suggestions for coding materials that may be helpful to me would be appreciated.  Here is the procedure I'm struggling with now:

Sacroiliac Joint Injection and L5 Dorsal Ramus Injection @ sacral ala

22 GSpinal Needle 3.5 insches long
40 mg Depo-Medrol
.25% Bupivacaine - 2cc

Patient prone during injection.  All pressure points paaded.  Inj site prepped and draped.  C arm was positioned in the oblique plane.  Spinal needle was advanced to the Left SI Joint using constant fluoroscopic guidance.  Once the needle was in position, copies of the needle position were undertaken and are in patient's chart.  Repeated aspirations thoughout the procedure were negative for air, blood, CSF, or other fluid.  Medication was then injected into the Left SI joint as mentioned above.  The same procedure was repeated for the L5 Dorsal ramus injections.  

I was thinking
27096 
64493


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## dwaldman (Jan 16, 2013)

Usually when L5 medial branch is blocked at the sacral ala, also L4 medial branch would be blocked at L5, to treat the L5-S1 facet joint. 

Might want to confirm with the physician that this is not an L5 lateral branch block innervating the SI Joint in conjunction with the SI joint intraarticular injection.

I am not familar with the anatomy of where the L5 Lateral branch landmark is but thought I would mention this because I have seen on coding forum examples where even though they state lateral branches L5-S1 in the procedure heading, they mention medial in the narrative section, so if I was billing for a physician that was known to perform lateral branch blocks innervate the SI joint I would confirm exactly what was performed if there was any question.


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