# S-1 Lateral spinal branch injections



## Art111085 (Apr 26, 2010)

Please help, my Dr. has dictated the following....

1.	64493 LUMBAR FACET INJECTION USING MEDIAL BRANCH TECHNIQUE
2.	RIGHT S-1 LATERAL SPINAL  BRANCH

He also has an addendum stating, S1 LATERAL BRANCH IS CODED LIKE A "PERIPHERAL NERVE BLOCK".

How should #2 be coded?

64450? 

Thanks
Amber


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## dwaldman (Apr 26, 2010)

If you look at this CPT Assistant article for S1 Lateral Branch Nerve Destruction they suggest reporting 64640. The corresponding non-neurolytic code would be 64450. The physician has the correct coding.



"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."

 "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)."


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