Ask an Expert

Answers to Compliance and Medical Coding Questions.
  1. Mike Posted 2 month(s) agoRelated Topics

    Patient had a L4 medial branch block and L5 dorsal ramus block. Would this be coded as 64493 only?

  2. SuperCoder Posted 2 month(s) ago


    Yes, the appropriate code is 64493 only.

    Please also check the below link:


  3. Mike Posted 2 month(s) ago

    Can't see the link only for anesthesia. Why pain management practice would not be able to see this link?

  4. SuperCoder Posted 2 month(s) ago

    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.

About this Question

  • Posted by 14912 Mike, 2 month(s) ago. There are 4 posts. The latest reply is from SuperCoder.