# SI branch injections



## colsonccsp@yahoo.com (Oct 9, 2012)

My provider performs an SI innervation block and I am not sure how to code it.  He says 64493-5 is not appropriate as it is not a facet.  He also says it is not a 27096 because he is not going into the joint itself but injecting the nerves that innervate the joint.  I am coming up with an unlisted code but since that pays very poorly.  I am inclined toward 64450-X2 in this case, s1-s2, s2-s3.  

I am hoping you wise coders out there can offer me some help.  

Documentation below: 

Sacroiliac joint block of the sacroiliac innervation S1, S2, and S3 branches.
Sacroiliac joint innervation was approached in mediolateral  projections and with tilt of the fluoroscopy unit caudal cephalad.  Then, 1% lidocaine was injected in the skin.  A 22 gauge spinal needle was inserted at the S1, S2, S3 innervation of the sacroiliac joint and branches of the innervated joint subsequently.  Negative aspiration was noted.  Contrast study was performed.  No intrathecal or intravascular spread was noted.  Subsequently, the block was performed using 0.2% Naropin mixed with 4mg/cc of Kenalog for a total of .5 cc at each location.  The patient tolerated etc . ..


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## Walker22 (Oct 10, 2012)

I agree with your provider on both points. You might try looking at 64483 & 64484, but I think 64450 might be the best code.


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## marvelh (Oct 10, 2012)

Actually the coding would be 64550 x 3 as the physician is blocking three separate nerve branches.  The coding for 64450 is not like the coding for facet joint injections.  

The following was published in the June 2012 CPT Assistant that addresses a destructive procedure of these 3 nerve branches:
​Question: May code 64640 be reported for each individual peripheral neurolytic nerve destruction procedure performed at the L5, S1, S2, and S3 nerves?

​Answer: Yes. When performing individually separate nerve destruction, each peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by
neurolytic agent; other peripheral nerve or branch. In this instance, for peripheral nerve root neurolytic blocks (destruction) of L5, S1, S2, and S3, code 64640 should be reported four times. The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings
of code 64640 to separately identify these procedures.


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## colsonccsp@yahoo.com (Oct 11, 2012)

Thank you so much for your help Marvel and Walker  and also thank you Marvel for posting that article!


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