Could I get opinion on how to code this? I feel it is 64490-RT C-2 but it has been questioned on if correct or not.

Would you code it as 64490-RT C-2…or 64490-RT-22 C-2… or 64490-RT C-2 AND 64450-RT TON?

Thank you!

After obtaining written consent, the patient was taken back to the fluoroscopy suite and placed in a prone position on the fluoroscopy table. The skin overlying the cervical spine area was prepped and draped in an aseptic fashion. The C2 transverse process, C3 transverse processes on the right were visualized under AP and slight oblique fluoroscopy. The skin and subcutaneous tissue overlying the target sites of injection were anesthetized using 0.25 ml of 1% lidocaine with a 25-gauge, 1-1/2 inch needle. (one needle used here)

A 25-gauge, 3-1/2-inch spinal needle with a bent tip was advanced under fluoroscopic guidance using a superior to inferior and lateral to medial approach to the scalloped edge of each of the transverse processes as well as the inferior lateral portion of the C2 vertebrae. (one needle here…right?) I do not see that multiple injections with multiple needles were used. One injection with needle to different areas…

The needles were then directed ventral, medial, and caudad to reach the target locations. After negative aspiration for heme or CSF, 0.25 ml of Magnavisc dye was injected at each site under live fluoroscopy, demonstrating absence of vascular uptake. After negative aspiration for heme or CSF, 0.5 ml of 0.25% bupivicaine was slowly injected at each site to avoid forcing the solution away from the target points. The needles were then removed. Sterile bandages were placed over injection sites.