# Medial branch block L5, sacral ala, S1 neural foramen on the left



## PatMacc (Sep 16, 2009)

I have read the other posts on medial nerve blocks and have found them very helpful.  I have one that is a bit werd. He says he does medial branch block at L5, the sacral ala and S1 neural foramen on left.

Light sedation, back prepped, Betadine x 3, teh C amr fluoro brought in to visualize transverse process at L5 and sacral ala.  Skin anesthetized with 1% lidocaine, approximately 2 cc were injected at each level.  At this point a 25 gauge curved tip spinal needle was advanced, made bony contact with medial superior most aspect of transverse process at L5.  Sacaral ala on the left and lateral aspect on the neural foramen on the left.  At this point 1 cc of 0.25% Marcaine plain with 10 mg of Depo-Medrol were injected.  

I am thinking one level, 64475-LT.  Another person thinks it should be 64475-LT, 64476-LT 64476-LT.  I think they are thinking the sacral ala and S1 neural foramen are different. Thanks in advance. These are confusing.


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## marvelh (Sep 22, 2009)

the needle placement at the L5 vertebrae is actually blocking the L4 medial branch; likewise the needle placement at the sacral ala is blocking the L5 medial branch;  in the past some providers considered there to be a small communicating sensory branch from the S1 nerve to the L5-S1 facet joint.  Anatomic research has found that not to be the case, however, since facet joint injection coding is based on facet joint spinal level and not necessarily the number of needles inserted, these three injections were performed to block the L5-S1 facet joint or one code as you were thinking - 64475 - LT


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## PatMacc (Sep 27, 2009)

Thank you Marvelh.   I thought I was on the right path however several coders had several opinions and it gets confusing. I am glad that you verified the coding of one level. Thank you so much for taking the time to answer my post.
Pat


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