medial branch blocks

Batavia, OH
Best answers
I am new to these procedures. I have been billing and coding for a physical medicine and rehabilitation group for awhile now. We recently got a new doctor and he is doing new procedures. Please advise on how to code this procedure:

The patient was placed in the prone position. Utilizing fluoroscopy, the L3, L4, and L5 areas were identified, target points for the diagnostic medial branch blocks were at the roots of the transverse processes of L3, L4, and L5 sacral ala with the superior articular processes. Appropriate sites were selected over the skin. The skin was prepared in sterile fashion. Local Anesthesia was carried out at each of the 6 entry sites with 1-2ml lidocaine 1%.
Utilizing a 25 gauge needle x3.5 inch under fluoroscopy, each of the 6 target sites were approached. AP and oblique viewpoints were utilized to ensure appropriate needle localization. Each of the 6 diagnostic blocks were carried out utilizing 0.5 cc of Marcaine 0.5%. The patient tolerated the procedure well.

The doctor marked his injection sheet as 64493-50, 64494-50, and 64495-50. I'm not sure how many levels were actually done. If what I've read is true this is only two levels.

Courtney Beatty CPC
Cincinnati OH
Last edited:
Your provider should document laterallity.
Otherwise, 64490-64495 are coded per level and your coding is correct.

Radiofrequency 64633-64636 are coded by facet joint, not level.
If you were coding RF, it would only be the two codes instead of three.