CPT® Code 64451

Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

The CPT® Code 64451 refers to the procedure of injecting anesthetic agents and/or steroids into the nerves that innervate the sacroiliac joint, utilizing image guidance techniques such as fluoroscopy or computed tomography. This procedure, commonly known as a sacroiliac (SI) joint nerve block, is primarily indicated for the treatment or diagnosis of low back pain and/or sciatic pain that arises from dysfunction of the SI joint. The sacroiliac joints are located where the sacrum meets the hip bones on either side of the spine, playing a crucial role in the stability and movement of the pelvis. During the procedure, the skin at the injection site is meticulously prepared to minimize the risk of infection. A needle is then carefully advanced into the SI joint, often under the guidance of fluoroscopy to ensure precise placement. Prior to the injection of the nerve blocking agent, a contrast medium may be introduced to confirm the correct positioning of the needle and to visualize the distribution of the medication. For diagnostic purposes, a local anesthetic, such as lidocaine, may be administered first, allowing the patient to assess pain relief. If significant pain relief, typically between 75-80%, is achieved, this can help establish a preliminary diagnosis. Subsequently, a different anesthetic agent, like bupivacaine, may be injected to further evaluate the persistence of pain relief, thereby confirming the diagnosis of SI joint dysfunction. In therapeutic scenarios, the injection may consist of an anesthetic agent combined with an anti-inflammatory corticosteroid, administered in a similar manner to alleviate pain and inflammation associated with the condition.