AAPC - Back to school
Results 1 to 3 of 3

Thread: Medial branch block L5, sacral ala, S1 neural foramen on the left

  1. #1
    Join Date
    Apr 2007
    Conway, SC

    Default Medial branch block L5, sacral ala, S1 neural foramen on the left

    AAPC: Back to School
    I have read the other posts on medial nerve blocks and have found them very helpful. I have one that is a bit werd. He says he does medial branch block at L5, the sacral ala and S1 neural foramen on left.

    Light sedation, back prepped, Betadine x 3, teh C amr fluoro brought in to visualize transverse process at L5 and sacral ala. Skin anesthetized with 1% lidocaine, approximately 2 cc were injected at each level. At this point a 25 gauge curved tip spinal needle was advanced, made bony contact with medial superior most aspect of transverse process at L5. Sacaral ala on the left and lateral aspect on the neural foramen on the left. At this point 1 cc of 0.25% Marcaine plain with 10 mg of Depo-Medrol were injected.

    I am thinking one level, 64475-LT. Another person thinks it should be 64475-LT, 64476-LT 64476-LT. I think they are thinking the sacral ala and S1 neural foramen are different. Thanks in advance. These are confusing.

  2. #2
    Join Date
    Apr 2007
    Denver Colorado


    the needle placement at the L5 vertebrae is actually blocking the L4 medial branch; likewise the needle placement at the sacral ala is blocking the L5 medial branch; in the past some providers considered there to be a small communicating sensory branch from the S1 nerve to the L5-S1 facet joint. Anatomic research has found that not to be the case, however, since facet joint injection coding is based on facet joint spinal level and not necessarily the number of needles inserted, these three injections were performed to block the L5-S1 facet joint or one code as you were thinking - 64475 - LT

  3. #3
    Join Date
    Apr 2007
    Conway, SC


    Thank you Marvelh. I thought I was on the right path however several coders had several opinions and it gets confusing. I am glad that you verified the coding of one level. Thank you so much for taking the time to answer my post.

Similar Threads

  1. Medial Branch Block of hip
    By cathy56 in forum Anesthesia
    Replies: 2
    Last Post: 12-02-2015, 11:23 PM
  2. Medial Branch Block L3-L5
    By alysonrs in forum Anesthesia
    Replies: 4
    Last Post: 08-11-2014, 10:50 PM
  3. Replies: 1
    Last Post: 02-12-2013, 09:10 PM
  4. C4 & C5 medial branch block One or Two levels??
    By MTrujillo in forum Anesthesia
    Replies: 1
    Last Post: 03-25-2011, 09:18 PM
  5. Medial branch block
    By MDPAYNE in forum Anesthesia
    Replies: 7
    Last Post: 04-09-2010, 10:00 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.