I have a provider that is doing Medial Branch Blocks in the office now 64493. If he is innervating the L5/S1 nerves/facets by injecting at the L4/L5, do you use the diagnosis for lumbosacral M54.17 or the M54.16 for lumbar??
64493 Right L4L5 Medical branch blocks innervating the Right L5S1 facet joint
History: This patient has had pain in the above noted lumbar facet distribution and has failed to respond to conservative measures. I have discussed the temporary nature of the diagnostic medial branch blocks and the risks to the patient, including bleeding, infection and direct nerve injury. Following my discussion, the patient wished to proceed.
Procedure: Patient's skin was marked preoperatively to indicate appropriate side and spinal level then taken to injection suite and positioned prone, prepped and draped in a sterile fashion. Blood pressure and oxygenation was monitored.
Attention was turned first to the RightL5 medial branch, target site being the junction between the sacral ala and the superior articulating process at S1. The skin over this area was anesthetized with 1% Xylocaine and then a 22-gauge spinal needle was advanced under fluoroscopic guidance until the tip of the needle came into contact with the target site, AP and lateral imaging studies were used to verify tip position. I next injected 0.5 cc of Isovue which showed a local non-vascular flow pattern at the target site. I next injected 0.5 cc of 0.5% Bupivicaine. The needle was then removed.
Attention was next turned to the RightL4 medial branch, target site being the junction between the transverse process and the superior articulating process at L4. The skin over this area was anesthetized with 1% Xylocaine and then a 22-gauge spinal needle was advanced under fluoroscopic guidance until the tip of the needle came into contact with the target site, AP and lateral imaging studies were used to verify tip position. I next injected 0.5 cc of Isovue which showed a local non-vascular flow pattern at the target site. I next injected 0.5 cc of 0.5% Bupivicaine. The needle was then removed.
Patient tolerated procedure well. Band aids were applied and patient was transported by wheelchair to the exam room. The patient's pro-op pain level was 2/10. Post-op, pain level was 0-1/10. The patient will keep a pain diary for the next 4 hours and will bring that back to their appointment for review in 2-3 weeks. No complications were noted at this time.