# ??? Rhizotomy



## KELLI (Nov 23, 2010)

Should I code it as 64622 64623 x4 ????

PROCEDURE:
1. Right L1 through S1 medial branch rhizotomy.
2. Percutaneous needle localization with _______ technique.

After obtaining informed consent, the
patient was taken to the procedure room, placed in prone position,
padded all pressure points. Sterile prepping and draping of the
entire lumbosacral spine area was done with Betadine solution, and
monitored anesthesia care was induced. Using right fluoroscopic
oblique at the junction of the SAP and transverse process, at 2
levels corresponding to the right L1 through L4 medial branches were
localized. A 10-mm active tip SMK needle was advanced through 3 mL
of 1% lidocaine to the target zone. Checked AP and lateral
projections and felt this was adequately placed. Oblique projections
were also used.

An AP projection at the junction of the right sacral ala and SAP, and
outside the 2 o'clock S1 foraminal aperture, 2 needles were placed in
similar manner, projected again in the AP and lateral oblique
projections. We then awakened the patient. Stimulation with 15 Hz,
0.5 volts to 1.5 volts, at 2 Hz per motor response did not produce
any right lower extremity stimulation. Each cannula had 1 mL of 2%
lidocaine placed followed by 60 to 70 degrees Celsius by the
Radionics generator, followed by 1 mL of 0.25% bupivacaine with 0.5
mg of Celestone by each cannula, and the cannulas were removed.

The patient was taken to the recovery room and, after 30 minutes, was
discharged in stable condition. He will follow up in 2 week with
explicit discharge instructions. He was given a prescription for a
Medrol Dosepak; he was explained the side effects.


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## dwaldman (Nov 23, 2010)

"at 2 levels corresponding to the right L1 through L4 medial branches were
localized."

At two levels? Should this say at the 3 levels corresponding......
L1,L2----L2-L3
L2,L3---L3-L4


"at the junction of the right sacral ala and SAP, and
outside the 2 o'clock S1 foraminal aperture, 2 needles were placed in
similar manner, projected again in the AP and lateral oblique
projections."

L5 at sarcal ala
S1 at S1 foramen


 He is not mentioning L1 at L2, L2 at L3, L3 at L4, L4 at L5, L5 at Sacral Ala. S1 at S1 foramen in the way that it is clear 6 separate nerves were individually treated with radiofrequency probe. I would talk to him because the body of the procedure note does not describe the details to be able to say it support exactly which nerves were treated in my opionion. I would ask him about the corresponding part. Were multiple nerves done at the two levels or were they individually treated.


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