BFAITHFUL
Expert
Can I use CPT code 64483, 64484x3 for diagnostic STEREOTACTIC injections at L5, S1, S2 and S3 lateral branches? In accordance to current literature and anatomic studies, the innervation of sacroiliac joints is supplied by ipsilateral lateral branches of L5, S1, S2 and S3 nerve roots.
I actually think it sounds more like they are doing the lateral branch blocks that provide innervation to the SI joint as a diagnostic to see if patient's pain is originating from the SI joint, particularly with description of "3 o'clock" and "9 o'clock" positions. If in fact it was the lateral branches, then they are coded as 64450 x 4 rather than as transforaminal epidural injections right???? Thanks
After 9800 fluoroscope was brought in and AP view of lumbosacral spine was obtained. The skin over the intersection of the articular process of L5 and sacral ala bilaterally was injected with 3cc of 1% lidocaine through a 25 gauge skin needle at each location and the skin wheals were raised. 3.5 inch 22 gauge spinal quincke needles were advanced through the skin negative and there was no paresthesia. Each level was injected with 1cc of 0.25% bupivacaine. At that point, visualization of opening of S1, S2 and S3 Foramina bilaterally was optimized via various degrees of cephalic and lateral tilt. The skin over the 3 o'clock positions of the foramina at S1, S2 and S3 on the right and 9 o"clock poitions of the foramina of S1, S2, and S3 on the left were injected with 3cc of 1% lidocaine through a 25 gauge skin needle and skin wheals were raised. 3.5 inch 22 gauge spinal Quincke needles were advanced through the skin wheals and guided towards the appropriate location until they contacted the bone. At that point, they were split into the rspective foramina. Aspirations were negative and there were no paresthesias. Each needle as injected with 0.5cc of Omnipaque 240. The resulting dye distributioin confirmed the respective nerve root sleeves. There was no evidence of intravascular dye. At this point each level was injected with 1cc of 0.25% bupivacaine. The needles were thenr emoved.
I actually think it sounds more like they are doing the lateral branch blocks that provide innervation to the SI joint as a diagnostic to see if patient's pain is originating from the SI joint, particularly with description of "3 o'clock" and "9 o'clock" positions. If in fact it was the lateral branches, then they are coded as 64450 x 4 rather than as transforaminal epidural injections right???? Thanks
After 9800 fluoroscope was brought in and AP view of lumbosacral spine was obtained. The skin over the intersection of the articular process of L5 and sacral ala bilaterally was injected with 3cc of 1% lidocaine through a 25 gauge skin needle at each location and the skin wheals were raised. 3.5 inch 22 gauge spinal quincke needles were advanced through the skin negative and there was no paresthesia. Each level was injected with 1cc of 0.25% bupivacaine. At that point, visualization of opening of S1, S2 and S3 Foramina bilaterally was optimized via various degrees of cephalic and lateral tilt. The skin over the 3 o'clock positions of the foramina at S1, S2 and S3 on the right and 9 o"clock poitions of the foramina of S1, S2, and S3 on the left were injected with 3cc of 1% lidocaine through a 25 gauge skin needle and skin wheals were raised. 3.5 inch 22 gauge spinal Quincke needles were advanced through the skin wheals and guided towards the appropriate location until they contacted the bone. At that point, they were split into the rspective foramina. Aspirations were negative and there were no paresthesias. Each needle as injected with 0.5cc of Omnipaque 240. The resulting dye distributioin confirmed the respective nerve root sleeves. There was no evidence of intravascular dye. At this point each level was injected with 1cc of 0.25% bupivacaine. The needles were thenr emoved.