# Bilateral Lateral Branch dorsal rami blocks



## LaVoncye (Jul 31, 2013)

My Dr. Performed a Bilateral lateral branch rami block at s1, s2,  and s3, Please what code should be used  for this procedure. It also stated the procedure was done under Fluoroscopy.

I thought it would be the 64450 X 3 with the modifier, now i'm not sure if It should bill the 64640  three time with the 59 modifier on the second and third, I'm confussed. When I asked the dr. he keeps saying there is a difference between the 64450 and the 64640. Looking at his not I don't know if it is a destruction or just a injection, or does it even matter. I'm sure it must as there are two different codes.

Please help!!!! 

Im holding this bill until I can get some information.


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## mosinskijm (Jul 31, 2013)

It does matter if there was destruction done, as that would be the 64640. If destruction was not documented, I would not code the 64640. Have you looked at 64493-64495?


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## LaVoncye (Jul 31, 2013)

Yes according to the consultant those codes should not be used. what about the 64450. I have been looking for key words in his notes to let me know if there was a destruction and there is nothing.


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## mosinskijm (Jul 31, 2013)

If nothing in the note about destruction-I would be ok with the 64450M50, 77003


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## dwaldman (Jul 31, 2013)

LaVoncye,

Look at the wording of what is performed: Bilateral lateral branch rami block at s1, s2, and s3

The term "block" would mean they are injecting typically an combination of steroid and anesthetic. This would fall under 64450.

If there was reference of Non-pulsed Radiofrequency ablation with time and temperature of ablation then you would look at 64640.

So S1, S2, S3 lateral branches, these would not innervate the facet joint so you can rule out 64493-64495. This would be for innervation of the sacroiliac joint, There is published articles from AMA CPT Assistant that states if individually nerve destruction are performed they are recommending 64640 per individual nerve destruction per for example non-pulsed radiofrequency ablation. If the documentation states it is pulsed per AMA CPT Assistant it would reported as 64999. If they state they used a probe that simulatenously ablates multiple nerve targets then 64999 is reported.

So since the AMA states that for the lateral branches that innervate the SI joint, that 64640 is used, it is considered the crosswalk to the non-neurolytic "block" would be 64450. 

Also consider that per NCCI, 77003 is bundled with 64450, so it would not be reported for Medicare or a carrier that follows NCCI. 

So you are going to have
64450-50 S1 Lateral branch blocked bilaterally
64450-50 51 S2 
64450-50 51 S3

With an additional note on the claim stating 3 levels performed bilaterally with the reported signed and ready to be sent.


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