# nerve branch block



## KELLI (Feb 22, 2011)

Could uses some guidance with coding nerve blocks.. I have attached the op report below I am torn between using 62311 x 3 or 64493, 64494, 64495??????


POSTOPERATIVE DIAGNOSES:
1.  Lumbago.
2.  Bilateral lumbar facet arthritis.

PROCEDURE PERFORMED:  Bilateral lumbar medial nerve branch block of
the dorsal primary ramus of L3, L4 and L5, utilizing fluoroscopic
guidance.

ANESTHESIA:  Monitored anesthesia care (MAC).

HISTORY:  The patient is a 70-year-old male who presents today with
the same complaints of axial lower back pain.  His pain presentation
remains unchanged.  His physical exam remains unchanged.  The risks
and benefits of the procedure were explained, which include but are
not limited to risks of infection, bleeding, worsening of back pain,
neurologic injury, and headache.  All questions have been answered.
The patient has given written informed consent for the procedure.
Due to the patient's significant past medical history of congestive
heart failure, cardiomyopathy, coronary artery disease, and automatic
implantable cardioverter-defibrillator (AICD) placement, as well as
the patient's pain anxiety and my need for the patient to remain
still for the procedure, it was decided to perform this procedure
utilizing monitored anesthesia care (MAC).

DESCRIPTION OF PROCEDURE:  The patient was brought into the procedure
suite and placed in the prone position with a pillow underneath his
abdomen to lessen lumbar lordosis.  C-arm fluoroscopy was used
throughout.  Sterile technique was used throughout.  His back was
prepped and draped in sterile fashion utilizing Povidone solution.
His lumbar spine was visualized in the AP view.  The C-arm was then
placed in a right lateral oblique position until an image of a
"scottie dog" was obtained. The target point for this procedure was
over the "eye of the scottie dog" of L4 and L5.  For the purpose of
the L5 dorsal primary branch, the target point was immediately
inferior and medial to the angle formed by the right S1 superior
articulating process and the right sacral alar.  Over each of these 3
target points, 1% lidocaine was infiltrated subcutaneously.  Through
each of these 3 lidocaine wheals, a #22-gauge spinal needle was
advanced utilizing a gun barrel view until periosteum was contacted.
The needle position was confirmed with multiple fluoroscopic views.
After negative aspiration of cerebrospinal fluid (CSF) or blood, I
then slowly injected 0.8 mL of bupivacaine 0.5% through each of the 3
needles.  The needles were withdrawn.  The procedure was repeated on
the left side. The patient's back was washed.  Sterile Band-Aids were
applied, and he was returned to the recovery room in stable
condition.


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## bethh05 (Feb 22, 2011)

The “paravertebral facet joint nerves” that provide innervations to the facet joints in the cervical, thoracic, and lumbar regions are the medial branches off the dorsal ramus. 62311 is coded once per level, once per side regardless of the number of injections per level and side.


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## SS62 (Feb 25, 2011)

64493
64494
64495

_______________
ss62 cpc, cascc


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