Ask Dr. Z

For the case below, the coder reported codes 64493-50 and 64494-50. However, the provider wants codes 64493-50, 64494-50, and 64494-59 to be reported. Which, if either, is correct?

"Procedure: Lumbar medial branch blocks, BILATERAL L3, L4, L5. The lumbosacral area was prepped with Chlorhexidine and draped in sterile fashion. The skin over the target medial branch nerves was anesthetized with 0.5% lidocaine. A 22 gauge 3.5-inch needle was inserted into the target medial branch nerve under fluoroscopic guidance at each level and location. No paresthesia was elicited with needle placement, and aspiration was negative for blood and CSF. Next a mixture of 40 mg of Triamcinolone mixed with 5 cc of Bupivicaine, 0.25% was evenly divided and injected at each level. An additional 0.5 ml of lidocaine was injected in the needle tract as the needle was withdrawn. The identical procedure was performed at the remaining levels. The skin was cleansed and a sterile bandage applied. Following the procedure the patient's vital signs were stable. Patient tolerated procedure well, and no complications were encountered."