Left Lateral Branch NB

lcole7465

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The pain doc performed a left lateral branch nerve block for sacroiliac joint specifically dorsal ramus of L5 and lateral branches of S1, S2. He wants only 64450 x3 coded. In the note I don't see any documentation that he actually injected at the L5, so I believe this would be correct.

Procedure Note: I identified the sacral ala and the superior articular process of S1. I advanced the needle until I had good position of the needle into the junction between the sacral ala and the superior articular process of S1. Then we identified the most median and superior part of the left SI joint. I advanced the needle towards the most lower and inferior portion of the SI joint on the left side until I had good position of the needle into the above level in the AP and lateral views. Following this, the needle trocar was removed and syringe containing 0.5% bupivicaine was attached. At each level, after syringe aspiration with no blood return, 0.8mL of 0.5% bupivicaine was injected to anesthetize the median branch nerve and surrounding tissue. All injected medications were preservative-free.

Any input would be greatly appreciated
 

dwaldman

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"I had good position of the needle into the junction between the sacral ala and the superior articular process of S1 "

Above is the L5 level. Below describes this location for a block of L5


"The L5 spinal nerve does not have a corresponding medial branch, but instead gives rise to a dorsal ramus that passes in the groove between the sacral ala and the superior articular facet of S1.19"
 
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