Wiki L4, L5, S1 Bilateral Medial Branch Blocks

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I want to make sure I understand how to bill MBBs. Please help me determine the levels per this op:

Lying in a prone position, the patient was prepped and draped in the usual sterile fashion using chloroprep and a fenestrated drape. Each site was identified under fluoroscopic guidance. Local anesthetic was given by raising a wheal and going down to the hub of a 27-gauge 1.25-inch needle. A 25-gauge 3.5-inch Quincke needle was advanced to the anatomic location of each medial branch at the junction of the superior articular process and transverse process utilizing intermittent fluoroscopy. Aspiration was negative. Medication (0.5 ml Bupivicaine 0.5%) was then injected slowly.

The procedure was completed without complications and was tolerated well. The patient was monitored after the procedure. The patient (or responsible party) was given post-procedure and discharge instructions to follow at home. The patient was discharged in stable condition. A follow-up appointment was confirmed.

Under fluoroscopic guidance, a 22G X 3.5 inch spinal needle was placed at the junction of SAP and transverse process of L4. Aspiration was negative for blood. A total of 0.5 cc of 0.5 % Bupivacaine was injected.

Under fluoroscopic guidance, a 22G X 3.5 inch spinal needle was placed at the junction of SAP and transverse process of L5. Aspiration was negative for blood. A total of 0.5 cc of 0.5 % Bupivacaine was injected.

Under fluoroscopic guidance, a 22G X 3.5 inch spinal needle was placed at the junction of SAP and transverse process of S1. Aspiration was negative for blood. A total of 0.5 cc of 0.5 % Bupivacaine was injected.


I am thinking the correct CPT codes to bill are 64493-50 and 64494-50. Should I be billing an additional level 64495-50?
 
This isn't my coding specialty, but I would have coded 64493, 64494 & 64495 for the three injections at three different levels. How are you reading this as a bilateral procedure? I don't see anything this documentation to support a modifier 50 - there's no laterality documented here.
 
L4-5, L5-S1 = 64493, 64494.

Per CMS guidelines: Facet joint- A diarthrodial joint in the spinal column (also called the zygapophysial joint or z-joint), producing the articulation of the posterior elements of one vertebra with its neighboring vertebra. They are bilateral superior and inferior articular surfaces at each spinal level. The terminology or nomenclature of the facet joint is classified by the specific vertebrae level that forms it (e.g., C4-5 or L2-3). There are two (2) facet joints, right and left, at each spinal level.
 
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