Pain Management 64451 versus 64493

Nancy Klein

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Can anyone tell me the difference between 64451 and 64493?

64451-states Injection of anesthetic; nerves innervating the sacroiliac joint

Versus

64493 states Injection of paravertebral facet joint (OR nerves innervating that joint), lumbar/sacral.

Both state that the nerves innervating the SI joint are injected. What’s the difference between the 2?

Thank you!!
 

bdcoyne8

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They are based on the joints. If you pull up an image, you will see the sacroiliac joint is on the sides of the vertebrae (more in the pelvis). The paravertabral facets are in the actual spinal column. Whey they are doing the 64493, they are targeting the L5-S1 facet joint nerves, that's why they include sacral in the terminology.

64451 targets the nerves in the sacroiliac joints (not the facets).

Hope this helps!
 
Last edited:

Blackhorse

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64451 is for injection, anesthetic agent, nerves innervating the sacroiliac joint; 64493 is for injections, diagnostic or therapeutic agent, paravertebral facet joint (or nerves innervating that joint), lumbar or sacral. 64451 can only be billed if anesthetic being injected and for sacroiliac joint; 64493 is normally used for treatment, using anti-inframammary drugs, I guess anesthetic also can be used for diagnostic purpose but the injection is for lumbar or sacral joint not sacroiliac joint. There is a difference between sacral and sacroiliac joint.
 

Nancy Klein

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They are based on the joints. If you pull up an image, you will see the sacroiliac joint is on the sides of the vertebrae (more in the pelvis). The paravertabral facets are in the actual spinal column. Whey they are doing the 64493, they are targeting the L5-S1 facet joint nerves, that's why they include sacral in the terminology.

64451 targets the nerves in the sacroiliac joints (not the facets).

Hope this helps!
Thank you.
How would you code a medial branch block OR Facet of S2-S3? The docs actually do L5-S3. Seems that would be 64493 (L5-S1) and 64451 (S2-3) but you can’t bill both together. Thoughts?
 

bdcoyne8

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It sounds like they are wanting to treat the sacroiliac portion of the spine so I would only code the 64451 since they can't be billed together. Bill for what they is wanting to treat. We have that with our providers as well. They are educated that only one can be billed so if they are treating lumbar but going into the sacrum, we only bill the lumbar if they are wanting to do it at the same visit. If they want to get billed for both, they are educated they will need to have the patient come back for the second portion as that is what their insurance allows.
 
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It sounds like they are wanting to treat the sacroiliac portion of the spine so I would only code the 64451 since they can't be billed together. Bill for what they is wanting to treat. We have that with our providers as well. They are educated that only one can be billed so if they are treating lumbar but going into the sacrum, we only bill the lumbar if they are wanting to do it at the same visit. If they want to get billed for both, they are educated they will need to have the patient come back for the second portion as that is what their insurance allows.
Hi! we have encountered a similar scenario in which the provider is performing the following:
  1. Fluoroscopically guided bilateral lumbar medial branch nerve blocks of the L3 and L4 levels.
  2. Fluoroscopically guided bilateral primary dorsal rami of L5 block at the level of the sacral articular process.
It is our understanding that the L5-S1 dorsal rami block is reported with 64451, while the L3 and L4 medial branch blocks are reported with 64493, +64494.
Per NCCI, the 64493 and +64494 are bundled into the 64451; how do you suggest coding for this scenario?

I question the use of 64451 because CPT assistant seems to indicate that it requires L5, S1, S2, S3, but the CPT book does not specify.
 
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