# RFA L4-L5 and Sacral Ala



## AB87 (Nov 1, 2018)

If a doctor performs a RFA on the L4-L5 it would be 64635. and if he places the needle in the Sacral Ala would it be 64640? or +64636?




Thank You for the Help in advance


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## dwaldman (Nov 2, 2018)

Here is from Marvel Hammer from this forum regarding Sacral Ala. This was in 2009.

https://www.aapc.com/memberarea/for...ock-l5-sacral-ala-s1-neural-foramen-left.html



marvelh  
Expert

......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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## dwaldman (Nov 2, 2018)

From her response if they are also doing the L4-5 Facet nerves, then L5 at the sacral ala would be for the L5-S1 facet denervation under 64636. You would want to confirm this for facet nerve ablation not SI joint as seen with 64640


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