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How to code MBB - Block from Lumbar L5 to S3? CPT 64451 versus CPT 64493

3/6/2023

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HOW TO CODE MBB - BLOCK FROM LUMBAR L5 TO S3? CPT 64451 VERSUS CPT 64493
Does this sound familiar? - ​BILLING CODING L5 DORSAL RAMUS AND S1, S2, S3 LATERAL BRANCH BLOCK
HOW TO CODE MBB - BLOCK FROM LUMBAR L5 TO S3? CPT 64451 VERSUS CPT 64493
HOW TO CODE MBB - BLOCK FROM LUMBAR L5 TO S3? CPT 64451 VERSUS CPT 64493
​When CPT code 64451 is performed from L5 to S3, it should be reported as a single unit of service regardless of the number of sacroiliac joints injected. Each sacroiliac joint should not be counted as a separate injection. This is because the injection is being performed at the sacral plexus, which is located near the sacroiliac joint but is a different structure.
This information is supported by the American Medical Association's CPT Assistant, which states that "when injection of the sacral plexus is performed at multiple levels (e.g., L4, L5, and S1), each level should be separately identified and reported with the -59 modifier appended to the additional levels beyond the first level." However, in the scenario you described, since the injection is being performed from L5 to S3, it should be reported as a single unit of service using code 64451 without any modifiers.
It is important to review the payer's specific coding and billing guidelines to ensure compliance with their policies. The Centers for Medicare & Medicaid Services (CMS) has also published guidelines on the appropriate use of CPT code 64451.
​
Source: American Medical Association. CPT Assistant. May 2013 Volume 23, Issue 5, Page 9. CMS National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 11, Section H (available on the CMS website).
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  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • Readers Questions
  • Artificial Intelligence Division