Right C2, C3 MBB and RiGHT TON Block


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Could I get opinion on how to code this? I feel it is 64490-RT C-2 but it has been questioned on if correct or not.

Would you code it as 64490-RT C-2...or 64490-RT-22 C-2... or 64490-RT C-2 AND 64450-RT TON?

Thank you!

After obtaining written consent, the patient was taken back to the fluoroscopy suite and placed in a prone position on the fluoroscopy table. The skin overlying the cervical spine area was prepped and draped in an aseptic fashion. The C2 transverse process, C3 transverse processes on the right were visualized under AP and slight oblique fluoroscopy. The skin and subcutaneous tissue overlying the target sites of injection were anesthetized using 0.25 ml of 1% lidocaine with a 25-gauge, 1-1/2 inch needle. (one needle used here)

A 25-gauge, 3-1/2-inch spinal needle with a bent tip was advanced under fluoroscopic guidance using a superior to inferior and lateral to medial approach to the scalloped edge of each of the transverse processes as well as the inferior lateral portion of the C2 vertebrae. (one needle here...right?) I do not see that multiple injections with multiple needles were used. One injection with needle to different areas...

The needles were then directed ventral, medial, and caudad to reach the target locations. After negative aspiration for heme or CSF, 0.25 ml of Magnavisc dye was injected at each site under live fluoroscopy, demonstrating absence of vascular uptake. After negative aspiration for heme or CSF, 0.5 ml of 0.25% bupivicaine was slowly injected at each site to avoid forcing the solution away from the target points. The needles were then removed. Sterile bandages were placed over injection sites.


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Below is part of a response I received from the AMA CPT Network, they stated it would be inclusive.

Inquiry Question:
I believe the below procedure should be coded as such: 64626 (C2), 64640 (TON), 64627 (C3), 64627 (C4) 77003

Is it appropriate to report 64640 for destruction of third occipital nerve by radiofrequency ablation?

Radiofrequency neuolysis cervical medial branches(facets) RIGHT X 4 Levels C2,TON, C3, C4 Fluoroscopy for needle guidance

Above was part of my question Below is part of their response

"64626 Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level

64627 x2 Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure)

77003 x1 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction

"It would not be appropriate to report code 64640 Destruction by neurolytic agent, paravertebral facet joint nerve; other peripheral nerve or branch. The third occipital nerve is the medial branch of C-3 and its location is similar anatomically with performing a paravertebral facet joint injection. However, the difference is that the location of the third occipital nerve may
vary, so the physician may need to burn over a wider area to ensure capturing the third occipital nerve in the procedure."
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Occipital block at c2/3 with Medial branch block at same level

Is it appropriate to bill 64450 and 64490 at same level. My physician documented as TON was performed at c2/3 and Medial branch block was performed at same level. I am unsure whether both can bill during same visit. Awaiting for reply. Thank you!!