Wiki Branch blocks and RFA's from L4-S2

[sarab86]

Need some help here. In 2020 there are now codes for Nerve blocks and Radiofrequency done at the nerves that innervate the sacroiliac joint. 64451 and 64625

My question is if a provider performs a Medical Branch Block from L4-5, L5-S1 ans S1-S2 how would that now be coded? In the past we have used 64450 for S1-S2 because that is actually a lateral branch block there. However CPT says now that you are not to report 64451 with 64493-64495. So would he no longer be able to extend the block down past S1? At times he does L5-S1, S1-S2, and S2-S3.

Any guidance would be appreciated. I have called AAPM and Decision Health and got no help, as well as 2 different webinars and none of the proctors would answer my question.

 

[jkyles]

Hi, he could do the block and you would report it with 64451.

The scenario in the 2020 CPT Changes states in part: "Target the L5 dorsal ramus nerve at the junction of the sacral ala and S1 superior articular process. Target the S1, S2 and S3 nerves at the posterior lateral foramen of the

S1, S2 and S3 foramen​

, respectively."

 

[aubwe2000]

Hi, he could do the block and you would report it with 64451.

The scenario in the 2020 CPT Changes states in part: "Target the L5 dorsal ramus nerve at the junction of the sacral ala and S1 superior articular process. Target the S1, S2 and S3 nerves at the posterior lateral foramen of the
S1, S2 and S3 foramen
, respectively."

Hello, I am also struggling with understand these codes.

My Dr is doing this procedure?
RFA LUMB/SAC FACET JNT- 1ST LEVEL (Left L5-S1); RFA PERIPHERAL NERVE (Left S1-3) in a quantity of 3

How would this be handled with the new codes? Would I just do the 64635, and 64640? Or would I just continue with 64635, 64636?

If you could point me in the direction?

 

[jkyles]

Hi I'm still researching this but for now perhaps a bit of good news: CCI isn't following the CPT manual.

 

[Slizs1283]

Hello, my provider performed a bilateral medial branch block of L5 to S1 and Sacral Lateral Branch Block at S1. The provider would like to bill both CPT codes 64451 and 64493 but the CPT manual says you can't bill these 2 codes together. Which code should I pick in this situation? Thanks.