Sorry I should have put this in the information from MHammer:
For a period of time, some providers considered the L5-S1 facet joint to have innervation from 3 nerve branches rather than the standard two...
L4 medial branch that is injected at the L5 vertebral body
L5 dorsal ramus that is injected at the sacral ala
AND a communicating branch from the S1 spinal nerve.
Newer anatomic research has found that there isn't a communicating branch as once thought and many pain mangement providers now only inject the L4 medial branch and the L5 dorsal ramus to block the L5-S1 facet joint.
With that said, the provider is still only blocking 1 facet joint level - L5-S1 and as such would be reported as 64493
Also to say that I am looking for where she may have gotten the information from a book showing this or where. I am telling Dr one code 64493 or 64493/50 if bilateral, but I am looking for more corroboration to show my doctor possibly newer for 2012 info would be great too.
I had also seen this:
06-07-2011, 10:28 AM
theso13
New Join Date: Apr 2007
Posts: 7
MNBB and Dorsal ramus injections
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Our doctor wants to bill for L4-5 median nerve branch block as well as for a L5 dorsal ramus procedure. Can both 64493 and 64494 be billed with these levels?
#2
06-08-2011, 07:55 PM
dwaldman
True Blue Join Date: Apr 2007
Posts: 611
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Below CPT Assistant references would support two facet levels in the lumbar region represented by 64493 as described by the L3,L4 medial branches that innervate the L4-L5 facet joint and 64494 for the L4 medial branch and L5 dorsal ramus innervating the L5-S1 facet joint.
August 2010 CPT ASSISTANT
The L3, L4, and L5 medial branch nerves innervate the L4-L5 and L5-S1 facet joints. Therefore, code 64493,Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level,is reported for the first joint injected or blocked (L4-L5). Code 64493 is reported for a single or initial level treated. Add-on code 64494,Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure),is reported for the second joint or level injected or blocked (L5-S1).
Additionally from September 2004 CPT ASSISTANT
"It should be further emphasized that codes 64475, 64476, 64479, and 64480 refer to the injection of a facet joint either by injection into the joint with one needle puncture or by anesthetizing the two medial branch nerves that supply each joint (two needle punctures). For example, a left-sided L4-L5 intra-articular injection performed with a single needle puncture would be coded as 64475. Injection of the L3 and L4 medial branch nerves supplying the L4-L5 facet joint would also be coded as 64475, even though two separate injections are performed to effect the same result."
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