# Lumbar facet arthropathy



## ortho1991 (Sep 25, 2013)

Hi,

Not very familary with pain coding. I hope someone can help me.

Here is the op-note.

LT L3-L4 medial branch plus and L5 lateral branch block with fluor guidance.

The skin and subcutaneiou tissue over the target area was then anesthetized using --Lidocaine with a 25-gauge 1.5 inch needle.  With intermittent fluoroscopy to minimize the dose of radiation, a 22- gauge spinal radiofrequency needle was advanced to the juction of the superior aspect of the targeted transverse process and the lateral aspect of the superior articulatiing process at the same level.  The needle was then walked over the transverse process and advancecd 2 to 3 mm to lie along the path of the corresponding medial brance nerve.  AP and lateral images were obtained to verify proper needle position.  Sensory and motor stimulation were then performed, which elicited deep local back discomfort but no evidence of motor stimulation in the lguteal musches or exteemities.  These values are recorded in the nursing notes.  After negative aspiration for air, blood or CSF, a solution consisting of 1ML of --Lidocaine wa injected and a perior of one minute wass allowed to elapse in order for the nerve to become anesthetized.  Nerve  branch denervation was performed for a period 90 seconds at 80 degrees Celsius with a 15 second ramp up time.  -----  .  This procedure was performed at each of the above mentioned sites.


We are looking at 64635 64636.   Is this correct?  Are there any other codes we should bill?

Please any help or guidance on this will be very much appreciated

Thank you


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## brendalewing (Sep 25, 2013)

Probably 64493, 64494, and 64495, with maybe 62311 and 99236-25.. modifiers would be needed on the injections if bilateral. Check your LCD with CMS provider for diagnosis. We use 721.3, lumbosacral spondylosis


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## marvelh (Sep 25, 2013)

Yes, the procedure note suppports:
64635 - LT x 1
64636 - LT x 1

in that the three paravertebral facet joint nerves that were RF ablated provide sensory innervation from two joints: L4-L5 and L5-S1

the image guidance, injection of local anesthetic, etc. is considered to be part of the radiofrequency destruction and not separately billable.


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## johnmeyer (Sep 29, 2013)

Agreed....

64635-LT x 1
64636-LT x 1

Dx 721.3 as this is the only code we can get payment on.


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