Hello all! I am getting mixed feedback regarding injections one of my providers is performing. She states it is a Lateral Branch Block (LBB) and is coded 64450 x3 units. We are getting rejections from Medicare stating the documentation supports a Medial Branch Block (MBB) 64493. I've also gotten feedback through supercoder stating we should be coding 64493 x1 and 64450 x2. As far as I am aware LBBs, 64450, are done to block pain from the SI joint while MBBs, 64493, are done for pain from the facet joint. If I could please get some feedback on this I'd greatly appreciate it. Dictation is below. 
" The pros and cons of the procedure were discussed with the patient. Risks, benefits and side effects were explained. Informed consent was obtained. The patient was taken to the fluoroscopy suite and placed in a prone position. Under fluoroscopic guidance, the anatomic location of the L5 primary dorsal ramus, as well as the S1 and S2 posterior formen were identified using an AP and Oblique view. The skin was prepped with Betadine and 1% Lidocaine. Next, in an AP view, a 23 gauge spinal needle was advanced to the location of the L5 dorsal primary ramus at the junction of the superior articular process and sacral ala, as well as the lateral branch nerves at the lateral border of the posterior sacral foramen. Aspiration was negative at that point for heme or parasthesias. Special care was taken to locate the appropriate site so that the lateral branch block being performed was done on the indicated nerves therefore blocking the nerves innervating the SI joint. After appropriate visualization of no epidural placement in a lateral view and appropriate placement confirmed in a 30 degree oblique view for ala, an injection of 0.5ml of 0.75% Marcaine was injected at each level with frequent negative aspirations. The needles were removed. The patient tolerated the procedure well. The patient was released home with pain diary to be completed and brought back during next visit."
" The pros and cons of the procedure were discussed with the patient. Risks, benefits and side effects were explained. Informed consent was obtained. The patient was taken to the fluoroscopy suite and placed in a prone position. Under fluoroscopic guidance, the anatomic location of the L5 primary dorsal ramus, as well as the S1 and S2 posterior formen were identified using an AP and Oblique view. The skin was prepped with Betadine and 1% Lidocaine. Next, in an AP view, a 23 gauge spinal needle was advanced to the location of the L5 dorsal primary ramus at the junction of the superior articular process and sacral ala, as well as the lateral branch nerves at the lateral border of the posterior sacral foramen. Aspiration was negative at that point for heme or parasthesias. Special care was taken to locate the appropriate site so that the lateral branch block being performed was done on the indicated nerves therefore blocking the nerves innervating the SI joint. After appropriate visualization of no epidural placement in a lateral view and appropriate placement confirmed in a 30 degree oblique view for ala, an injection of 0.5ml of 0.75% Marcaine was injected at each level with frequent negative aspirations. The needles were removed. The patient tolerated the procedure well. The patient was released home with pain diary to be completed and brought back during next visit."