CynthiaT
Guest
I am new to coding pain management & find that I am confusing myself when it comes to determining what constitutes a 'level' for medial branch blocks. Please help! 
here is the op report:
Procedure performed: Medial branch blocks for left L4-L5 and L5-S1 facet joints utilizing fluoroscopy.
Description of the Procedure:
The patient was identified. A written and verbal informed consent was obtained. Vital signs were evaluated and monitored throughout the procedure. IV access was obtained in the upper limb. Upon initiation of the procedure, the patient received 2 mg of Versed after being positioned prone on the fluoroscopy table in the OR. The skin overlying the lumbar and sacral region was thoroughly cleansed with Betadine solution and draped in a sterile fashion. Visualization of the lumbar and sacral region was obtained utilizing fluoroscopic imaging. Predicted locations as expected for medial branch nerves and dorsal rami of L3, L4, L5 were identified with fluoroscopy. The skin and the subcutaneous tissue overlying the predicted sites were penetrated and anesthetized with a 27-gauge 1.5-inch and 1% buffered lidocaine following negative aspirations for blood. Then, 22-gauge 3.5-inch Quincke spinal needles were then guided towards these locations on the left for medial branch blocks at L3, L4, and dorsal rami of L5 utilizing AP and oblique views. The procedures were performed at the transverse process of L4 intersecting with a vertebral body, the transverse process of L5 intersecting with the vertebral body and the sacral ala. Once it was determined that we were in the proper location, following negative aspirations for blood, the patient received as well amount of contrast Omnipaque 180 to ensure proper location and the absence of intravascular injection. The patient then received at each site less than 0.5 mL of injectate following negative aspirations for blood and and/or CSF at each of the three location. Injectate included a mixture of 2 mL of 0.75% Marcaine and 1 mL (6 mg/mL) of betamethasone. One the injections were performed, stylets were replaced in the needles and the needles were withdrawn. The skin overlying the injection site was thoroughly cleansed. Adhesive bandages were placed and the patient was returned to the recovery area where she received postprocedure instructions from the nursing staff in a written and verbal format. There was no evidence of intravascular or intraneural injection. There were no complications with the procedure. The patient was stable and ambulatory at the time of discharge.
So, would this be coded: 64493-LT, 64494-LT, & 99144
or: 64493-LT, 64494-LT, 64495-LT, & 99144
Thank you so much for your help!!!
here is the op report:
Procedure performed: Medial branch blocks for left L4-L5 and L5-S1 facet joints utilizing fluoroscopy.
Description of the Procedure:
The patient was identified. A written and verbal informed consent was obtained. Vital signs were evaluated and monitored throughout the procedure. IV access was obtained in the upper limb. Upon initiation of the procedure, the patient received 2 mg of Versed after being positioned prone on the fluoroscopy table in the OR. The skin overlying the lumbar and sacral region was thoroughly cleansed with Betadine solution and draped in a sterile fashion. Visualization of the lumbar and sacral region was obtained utilizing fluoroscopic imaging. Predicted locations as expected for medial branch nerves and dorsal rami of L3, L4, L5 were identified with fluoroscopy. The skin and the subcutaneous tissue overlying the predicted sites were penetrated and anesthetized with a 27-gauge 1.5-inch and 1% buffered lidocaine following negative aspirations for blood. Then, 22-gauge 3.5-inch Quincke spinal needles were then guided towards these locations on the left for medial branch blocks at L3, L4, and dorsal rami of L5 utilizing AP and oblique views. The procedures were performed at the transverse process of L4 intersecting with a vertebral body, the transverse process of L5 intersecting with the vertebral body and the sacral ala. Once it was determined that we were in the proper location, following negative aspirations for blood, the patient received as well amount of contrast Omnipaque 180 to ensure proper location and the absence of intravascular injection. The patient then received at each site less than 0.5 mL of injectate following negative aspirations for blood and and/or CSF at each of the three location. Injectate included a mixture of 2 mL of 0.75% Marcaine and 1 mL (6 mg/mL) of betamethasone. One the injections were performed, stylets were replaced in the needles and the needles were withdrawn. The skin overlying the injection site was thoroughly cleansed. Adhesive bandages were placed and the patient was returned to the recovery area where she received postprocedure instructions from the nursing staff in a written and verbal format. There was no evidence of intravascular or intraneural injection. There were no complications with the procedure. The patient was stable and ambulatory at the time of discharge.
So, would this be coded: 64493-LT, 64494-LT, & 99144
or: 64493-LT, 64494-LT, 64495-LT, & 99144
Thank you so much for your help!!!