We make it easy to find the online medical coding solution with just the features you need! |Learn More >>

Regular Price: $24.95

Ask an Expert Starting at $24.95

Have a medical coding question? Get definitive answers from TCI SuperCoder's Ask an Expert.

Browse Past Questions By Specialty

+View all
Mike Posted Tue 14th of November, 2017 09:53:21 AM
Patient had a L4 medial branch block and L5 dorsal ramus block. Would this be coded as 64493 only?
SuperCoder Answered Wed 15th of November, 2017 02:21:25 AM
Mike Posted Wed 15th of November, 2017 13:49:25 PM
Can't see the link only for anesthesia. Why pain management practice would not be able to see this link?
SuperCoder Answered Thu 16th of November, 2017 01:01:17 AM

Reader Question: Remember to Count Correctly for Medial Branch Blocks


Question: How should we code for a medial branch block (MBB) of L2-3, L3-4, and L4-5?



Answer: Some patients may require a targeted medial branch nerve block rather than a regular facet joint block. Each facet joint is supplied by the medial branches of two different spinal nerves. For example, the facet joints at L2-L3 are supplied by medial branches from the L1 and L2 spinal nerves. For this reason, the physician must block two median nerves for each facet joint. In the case of a medial branch nerve block at L2-L3, for example, the physician would inject the medial branches of L1 and L2. For coding purposes, these two injections are considered a single injection service.


The following codes are used for facet joint injections and medial branch nerve blocks:

• 64493 – Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level

• 64494 – … second level (List separately in addition to code for primary procedure)

• 64495 – … third and any additional level(s) (List separately in addition to code for primary procedure).


Note: CPT® includes several anesthesia codes for procedures in the lumbar region. These include:

• 00630 – Anesthesia for procedures in lumbar region; not otherwise specified

• 00632 – … lumbar sympathectomy

• 00635 – … diagnostic or therapeutic lumbar puncture

• 00640 – Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine.

Related Topics