# Ascending Accessory S1 nerve branches



## bugsy4cpc (Jan 20, 2012)

Doc is referencing L3,4,5 S1 AND ascending accessory S1 nerve branches for a radiofrequency facet nerve denervation.  IS ascending accessroy S1 nerve branches considered an additonal level... i.e. 5 LEVELS opposed to 4?


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## CatLaw (Jan 20, 2012)

Anything is the S1 level would be destruction on that one level.  Now, if he continued to the S2 level, then that would be an additional level.  If he is going beyond the S1 level, he needs to specify the additonal levels (S2, S3, etc..)  But accessory S1 is still one level.


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## dwaldman (Jan 21, 2012)

With the coding for 2012 radiofrequency ablation being per facet joint, S1 branch would be included in the L5-S1 level


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## dwaldman (Jan 21, 2012)

"Each lumbar FJ is innervated by the medial branches of the primary dorsal rami from that level and the level above (45,46). For example, the FJ L4-L5 are innervated by
both the L4 and the L3 medial branches. The L1-L4 medial branches of the dorsal rami run across the superior portion of the subjacent transverse process, under the mamillo-
accessory ligament at the junction of the superior articular process and the root of the transverse process, and then onto the lamina. On the lamina, the nerve divides, giving off branches to the FJ below, the joint at that level, the interspinous ligament and muscle, and the multifidus muscle. The L5 dorsal ramus runs in the groove between the superior articular process of S1 and the sacral ala (13,47,48). The medial branch of L5 divides from the dorsal ramus of L5 at the inferior aspect of the FJ L5-S1. A communicating branch from the S1 posterior ramus may travel from the superior edge of the posterior S1
foramen up to the inferior margin of the FJ L5-S1 (48)."

http://www.laboratoriosilesia.com/upfiles/sibi/R1107918.pdf


As seen above they describe "a communicating branch from the S1 posterior ramus"  if this is being treated in addition to L3, L4 ,and L5, these would be counted towards the following facet joint levels
L5-S1-----L4,L5, communicating branch S1
L4-L5-----L3, L4

64635
64636


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