Facet & Foraminal Injections

dyoungberg

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I need some direction on how to code this op note. I'm leaning towards 64493 & 64483. Would this be correct?

PREOP DIAGNOSIS: LEFT LOWER EXTREMITY PAIN SECONDARY TO FACET ARTHROSIS AT L5-S1 ON THE LEFT AND FORAMINAL STENOSIS

POSTOP DIAGNOSIS: SAME

PROCEDURE:
1. INJECTION OF L5-S1 FACET ON THE LEFT WITH FLUOROSCOPIC GUIDANCE
2. FORAMINAL INJECTION L5-S1 LEFT

ANESTHESIA: 1% XYLOCAINE W/EPI

DESCRIPTION: The patient was placed on the operative table, prone position. The back was prepped with Betadine. The C-arm was brought in for visualization. The skin overlying the L5-S1 facet on the left side was identified and anesthetized with 1% Xylocaine w/epinephrine. A 20G spinal needle was then directed into the L5-S1 facet on the left side. It was then injected with a mixture of 2 cc 0.25% Marcaine and 1 cc triamcinolone 40 mg. The needle was then directed more lateral over the edge of the facet to the vicinity of the outer foramen and was injected with 20 mg triamcinolone and 1 cc 0.25% Marcaine. The patient's spine was very deep. A standard 3" spinal needle would not reach down to the facet. We had to use a 6" needle and the facet was about 5 inches deep. This made it a bit difficult to accomplish the procedure. However, it was felt that the needle was placed well on the L5-S1 facet and at the outer foramen. The needles were then withdrawn. The patient experienced no undo symptomatology with insertion of the needles, injection process, or withdrawal of the needles. She tolerated the procedure well and returned to the recovery room in good condition.

Thanks very much for the assistance!
 

dwaldman

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"20G spinal needle was then directed into the L5-S1 facet on the left side. It was then injected with a mixture of 2 cc 0.25% Marcaine and 1 cc triamcinolone 40 mg. The needle was then directed more lateral over the edge of the facet to the vicinity of the outer foramen and was injected with 20 mg triamcinolone and 1 cc 0.25% Marcaine. The patient's spine was very deep. A standard 3" spinal needle would not reach down to the facet. We had to use a 6" needle and the facet was about 5 inches deep. This made it a bit difficult to accomplish the procedure. However, it was felt that the needle was placed well on the L5-S1 facet and at the outer foramen. "

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I would query the performing physician. I believe it is a facet injection with additional injections performed, but as the the procedure note reads, there are multiple descriptions of facet injections even when the foramen is mention, the note goes back to blocking the facet.
 
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