HELP reading anatomy of spine for pain code op note - facet joints & levels for MBB


Bangor, Maine
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HELP reading anatomy of spine for pain code op note - facet joints & levels for MBB

I code for ASC and usually my centers are very specific identifying the facet joint spaces in the op reports for ablations and medial branch blocks...

I was asked to review work for a coder who has more experience than myself and am having a hard time understanding how she is reading this op note as two levels for a medial branch block injection procedure. Can someone use this op report verbiage below to explain to me how I can interpret two levels vs. one? I would have read this as one facet space L3/L4:

"The left side of the patient was identified by the physician prior to embarking upon the procedure. In an oblique radiographic view, the sulcus of L3 and L4 were located radiographically and marked on the skin. The skin was prepared sterilely with Betadine and sterilely draped. Then, 0.5 mL of 1% lidocaine was injected in subcutaneous and soft tissues at each vertebral level. Thereafter, 22-gauge x 3-1/2-inch spinal needles were inserted to the level of bony landmark. No blood or fluid was able to be aspirated.

Then, 0.5 mL of Omnipaque-300 was injected and an outline of the medial branch nerve at the left L3 and L4 was obtained. Following this, 0.75 mL of 1% lidocaine was injected into each location. No complications occurred from the procedure. Pulse and blood pressure monitoring remained stable throughout."

The coder chose: 64493-LT, 64494-LT, and M47.816

Thanks in advance.