# L3-L4 Synovial Cyst Asp w/Facet Block



## cswift (Jul 21, 2010)

Can anyone advise as to whether it is appropriate to code 64493-77002 along with a cyst aspiration 10160-77002 at the same site? Dictation is below...any input would be great....thanks in advance!

CSwift

HISTORY: 59-year-old female with worsening low back pain and left leg
pain. Recent outside MRI demonstrated a prominent synovial cyst
projecting medially off of the left L3-L4 facet joint. Patient is
referred now for cyst aspiration and facet block.

Intravenous fentanyl was utilized for today's surgery.

After obtaining informed consent patient's lower back was sterilely
prepped and draped. Local and deep periarticular anesthetic was
applied. A 14-gauge crown needle was then hammered into the left L3-L4
facet joint under continuous fluoroscopic guidance. Once the needle
was appropriately positioned, a facet arthrogram was performed to
document good intra-articular positioning. There was also noted to be
communicating with a saccular recess extending into the spinal canal
consistent with the recent MRI findings. Aggressive manual aspiration
was then performed with removal of 1 to 2 cc of clear synovial fluid.
A second 14-gauge needle was then advanced down into the facet joint
utilizing similar techniques. Aggressive manual capsular disruption
was then  performed utilizing these two stiff needles. The facet joint
was irrigated with several cc of Marcaine an approximately 1 cc of
Depo-Medrol was instilled intra and extra-articularly at this site.
The needles were removed and patient left radiology in stable
condition.

IMPRESSION: Uncomplicated left L3-L4 synovial cyst aspiration, facet
block and capsular disruption is performed as described above.


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## RebeccaWoodward* (Jul 21, 2010)

Inclusive...


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## L_Silva CPC (Jul 22, 2010)

You can use the cyst rupture along with the facet block, however I would code it  64493-facet block which includes the fluoro along with 77003-59 and 20612 for the cyst rupture. hope this helps.


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## RebeccaWoodward* (Jul 23, 2010)

Per CCI edits, 64493 is a component of 20612 and it would not be apppropriate to unbundle the services since we are talking about the same level.


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