Mike Posted Wed 01st of April, 2015 17:45:09 PM
Doctor note says- Quincke tip needles were inserted in the SULCUS BETWEEN the right S1 superior articular process and the SACRAL ALA in the LOCATION of the L5 dorsal ramus nerve for the LAREAL BRANCHES. Following this the injectable spread along the SULCUS and in the distribution of the right L5 dorsa ramus. So would this be code 64493 or 64450? Is this injection location more out of the L5 joint so it would be the 64450 code??
SuperCoder Answered Thu 02nd of April, 2015 03:57:46 AM
Each spinal dorsal ramus arises from the spinal nerve and then divides into a medial and lateral branch. Lateral branch innervates the tissues lateral to the zygapophysial joint line. For L5 dorsal ramus nerve for the lateral branches 64450- "Injection, anesthetic agent; other peripheral nerve or branch" is appropriate.
Mike Posted Thu 02nd of April, 2015 11:44:19 AM
I have seen 2 codes to use for L5 Dorsal Ramus Block from SuperCoder.-64650 and 64493. I really need clarification of which code is correct. I also need to know which code is correct for an RF of the L5 Dorsal Ramus with RF S1, S2, S3, S4 of the SI joint. The coding goes back and forth. We have used 64635 and 64640 X4 on the RF.
SuperCoder Answered Fri 03rd of April, 2015 10:30:40 AM
64650 is not the CPT for L5 Dorsal Ramus Block, I guess this is a typing mistake.
Well, there is big difference between CPT codes 64493 and 64450.
In the procedure code 64493 the injection is being administered with the help of "IMAGE GUIDANCE like FLUROSCOPY or CT" and in the procedure code 64450 there is no use of any image guidance such as fluoroscopy or CT. Therefore, in given the scenario CPT 64450 is appropriate.
For RF of the L5 Dorsal Ramus with RF S1, S2, S3, S4, CPT codes 64635 and 64636(for each additional facet joint) are the appropriate.
Mike Posted Mon 06th of April, 2015 10:01:34 AM
Sorry it was a typo 64450.
There has to be more of a difference other than image guidance. We use Fluor when doing a block on the L5 dorsal ramus.
64450 does not mean you can't bill and perform Flouro, so like I said SuperCoder has given both codes for a L5 dorsal ramus block 64493 AND 64450. Is there something in CPT assist that states what is the correct code???
And again you gave codes 64635/64636 for a RF on the SI Joint and SuperCoder has given codes 64640 to be billed on the S1-S4 RF. If you do a L5 dorsal ramus RF as 64635 it would make sense you would use 64493 for the block?
SuperCoder Answered Tue 07th of April, 2015 08:00:34 AM
Yes I agree if you use fluoroscopy then bill it along with CPT 64450. Secondly, for a dorsal ramus block it is appropriate to bill 64493 as the facet nerve is medial branch of the dorsal rami and this procedure although performed differently is used to block fact joint only. Similarly if you are doing an RF for a nerve innervating sacral facet joint then 64493 is appropriate otherwise for any other nerve CPT 64450 is appropriate.
Mike Posted Tue 07th of April, 2015 12:11:43 PM
Thank you for your time with my questions
SuperCoder Answered Tue 07th of April, 2015 22:21:03 PM