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lumbar facet medial branch block L4 thru S1

Bill Posted Fri 15th of November, 2013 13:33:18 PM

If a patient is receiving lumbar facet medial branch blocks at the L4 thru S1 levels......is that 2 or 3 levels?

SuperCoder Answered Fri 15th of November, 2013 16:30:05 PM

L4-L5

L5-S1

These are two levels.

CPT Assistant page for back issues, in order for you to understand the coding from AMA/CPT perspective, it would be good idea to order the following

Year: 2004

Issue: September

Ttle: The Facets of Paravertebral Facet Joint Procedures (64470-64476, 64622-64627)

Below are some excerts from the article:

The paravertebral facet joint injection codes 64470-64476 should be reported per spinal level. Each vertebra in the spine is joined to the one above and the one below it by articular facet joints. There are four facet joints associated with each single vertebra in the spine below the level of C2 and above the level of S1. For example, at the L4 vertebral level, there is an L3-L4 facet joint at the upper end and also an L4-L5 facet joint at the inferior end.

Generally, each facet joint has dual innervation: one from the dorsal rami at the same level and one from the level above (eg, the L4-L5 lumbar facet joint is innervated by the medial branches of the dorsal rami from L3 and L4). Multiple injection levels are frequently performed when treating neck and upper back pain, as it is often difficult to isolate the exact joint level and two to three level injections may be performed at one sitting. Therefore, depending on the involved pathology, multiple-level facet joint and facet joint nerve blocks may be necessary for proper evaluation and management of chronic pain in a given patient.

Unlike facet joint nerve (medial branch) codes used to describe facet joint injection (64470-64480), facet nerve destruction codes 64622-64627 refer to individual nerve level destruction. Thus, although injection of the left L3 and L4 medial (facet joint) nerve would be code as 64475, destruction of the L3 and L4 medial branch nerves would be coded as 64622 and 64623.

Here is another recent Q and A from CPT Assistant

Year: 2010
Issue: August

Question:Lumbar medial branch blocks were performed on the right at L3, L4, and L5. Would codes 64490, 64491, and 64492 be reported because three different levels were injected?

Answer:No. The L3, L4, and L5 medial branch nerves innervate the L4-L5 and L5-S1 facet joints. Therefore, code 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,is reported for the first joint injected or blocked (L4-L5). Code 64493 is reported for a single or initial level treated. Add-on code 64494,Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral;second level (List separately in addition to code for primary procedure),is reported for the second joint or level injected or blocked (L5-S1). In this specific instance only, CPT codes 64493 and 64494 should be used, provided the injections were performed in the lumbar spine with fluoroscopic (or CT) guidance, as required to use codes 64490-64495.

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