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Thread: nerve branch block

  1. #1
    Join Date
    Apr 2007

    Default nerve branch block

    AAPC: Back to School
    Could uses some guidance with coding nerve blocks.. I have attached the op report below I am torn between using 62311 x 3 or 64493, 64494, 64495??????

    1. Lumbago.
    2. Bilateral lumbar facet arthritis.

    PROCEDURE PERFORMED: Bilateral lumbar medial nerve branch block of
    the dorsal primary ramus of L3, L4 and L5, utilizing fluoroscopic

    ANESTHESIA: Monitored anesthesia care (MAC).

    HISTORY: The patient is a 70-year-old male who presents today with
    the same complaints of axial lower back pain. His pain presentation
    remains unchanged. His physical exam remains unchanged. The risks
    and benefits of the procedure were explained, which include but are
    not limited to risks of infection, bleeding, worsening of back pain,
    neurologic injury, and headache. All questions have been answered.
    The patient has given written informed consent for the procedure.
    Due to the patient's significant past medical history of congestive
    heart failure, cardiomyopathy, coronary artery disease, and automatic
    implantable cardioverter-defibrillator (AICD) placement, as well as
    the patient's pain anxiety and my need for the patient to remain
    still for the procedure, it was decided to perform this procedure
    utilizing monitored anesthesia care (MAC).

    DESCRIPTION OF PROCEDURE: The patient was brought into the procedure
    suite and placed in the prone position with a pillow underneath his
    abdomen to lessen lumbar lordosis. C-arm fluoroscopy was used
    throughout. Sterile technique was used throughout. His back was
    prepped and draped in sterile fashion utilizing Povidone solution.
    His lumbar spine was visualized in the AP view. The C-arm was then
    placed in a right lateral oblique position until an image of a
    "scottie dog" was obtained. The target point for this procedure was
    over the "eye of the scottie dog" of L4 and L5. For the purpose of
    the L5 dorsal primary branch, the target point was immediately
    inferior and medial to the angle formed by the right S1 superior
    articulating process and the right sacral alar. Over each of these 3
    target points, 1% lidocaine was infiltrated subcutaneously. Through
    each of these 3 lidocaine wheals, a #22-gauge spinal needle was
    advanced utilizing a gun barrel view until periosteum was contacted.
    The needle position was confirmed with multiple fluoroscopic views.
    After negative aspiration of cerebrospinal fluid (CSF) or blood, I
    then slowly injected 0.8 mL of bupivacaine 0.5% through each of the 3
    needles. The needles were withdrawn. The procedure was repeated on
    the left side. The patient's back was washed. Sterile Band-Aids were
    applied, and he was returned to the recovery room in stable

  2. #2


    The “paravertebral facet joint nerves” that provide innervations to the facet joints in the cervical, thoracic, and lumbar regions are the medial branches off the dorsal ramus. 62311 is coded once per level, once per side regardless of the number of injections per level and side.
    Last edited by bethh05; 02-22-2011 at 01:54 PM.

  3. #3
    Join Date
    Apr 2007
    Philadelphia, PA



    ss62 cpc, cascc

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