Ask Dr. Z

How are the levels determined, and what are correct codes? "Medial branch blocks, left TON, C3, C4. Needle was advanced under fluoroscopic guidance to contact Os at the midpoint of the centroid of the articular pillar of C3, and C4, on the left. An AP view was then used to make sure that all needles were positioned correctly in the waists of the C3 and C4 articular pillars. Then 0.3 mL of 180 mg/mL Iohexol dye was injected at each site under fluoroscopy, and no vascular run-off was identified and dye spread was adequate. Then 0.5 mL of 0.5% Bupivicaine was injected at each level for the medial branch nerves at C3 and C4. We then returned to a lateral fluoroscopic view, and advanced the needle at C3 to the lateral C2-C3 junction (C2-C3 joint line). An AP view was used, where 0.3mL of 180 mg/mL Iohexol dye was injected under fluoroscopy to confirm extra-articular placement, and no vascular run-off was identified. An additional 0.5 mL of 0.5% Bupivcaine was injected at the TON level."