# Medial Branch Block L3-L5



## alysonrs (Jul 17, 2014)

How would you code the following procedure note?  64493 and 64494??

Any help would be appreciated!!


Procedure in Detail:
Informed consent was obtained. The benefits, alternatives and risks were discussed including, but not limited to, bleeding, infection, nerve injury, lack of pain relief, worsening pain, seizure, paralysis, bowel and bladder dysfunction and death. The patient chose to be brought to the procedure suite and was positioned with appropriate pressure points padded and comfortably awake. Monitors were laced and intravenous sedation was instituted. The patient was prepped and draped in strict sterile fashion. A multiplanar osseous screen was carried out over this anatomy to fluoroscopically identify the approach to the medial branches.

Tunnel vision, parallax and coaxial view were used as the anatomy was reviewed and the targets aligned. All structures were evaluated for approach over bony landmarks. Under fluoroscopic guidance, 3 1/2 inch, 22 gauge spinal needles were advanced percutaneously until the tips were at the superior, medial and posterior aspects of the transverse processes in oblique view at the junction with the articular facet. After negative aspiration, each was injected with a small amount of contrast media to ensure the absence of intraspinal or intravascular contrast spread.

Following this, 0.5 cc of 0.75% Bupivacaine plain was injected.

The needles were withdrawn, the area cleansed and BandAid applied. The patient will be taken to the recovery area for observation then discharged when in stable condition, having tolerated the procedure well. Follow up will be scheduled.


----------



## dwaldman (Jul 21, 2014)

Need to request an addendum to the note describe the levels addressed.


----------



## phammers66 (Jul 29, 2014)

I agree.  Not enough information in the note to code.  Don't see any nerves or joints mentioned....


----------



## Cmkuhlmey (Aug 9, 2014)

Based on the documentation provided I would code 64493, 64494, and 64495 for the 3 levels L3, L4, L5.


----------



## dwaldman (Aug 11, 2014)

Cmkuhlmey,
L3-L5 would have to be either:

L3-4, L4-5 facet joints for 2 levels 64493 64494

or

L3, L4, L5 medial branch block innervating L4-5, L5-S1 for 2 levels 64493 64494

Since these codes are reported per facet joint level, I don't believe you could pull more than 2 facet joint levels from L3-L5


----------

