Anesthesia Coding Alert

As the field of pain management continues to grow, knowing the differences between various approaches to the same procedure can give you a better understanding of coding. A good example of this is neurolysis, which basically means that a nerve is destroyed in some way to prevent it from carrying nerve signals and causing pain. The physician uses chemical, thermal, electrical or radiofrequency techniques (alone or in combination) to destroy the affected nerve. The procedures destroy the specific site in the nerve root that produces pain, but leave sensation intact. Chemical destruction involves injecting a neurolytic substance (such as alcohol, phenol or glycerol) into the affected nerve root to relieve chronic pain. The physician uses fluoroscopic guidance to insert a needle into the affected nerve root, and then inserts an electrode through the needle. A mild electrical current passes through the electrode and produces a tingling sensation at a specific site on the nerve. The physician manipulates the electrode until the patient feels the tingling sensation at the site of pain, then administers a local anesthetic and applies a neurolytic agent.

Thermal neurolysis techniques use heat to destroy the nerve. Electrical techniques use an electrical current. Radiofrequency, also referred to as radiofrequency rhizotomy or radiofrequency neurolysis, uses a solar or microwave current. The physician considers the location and type of pain as well as the equipment available to determine which technique will be most effective to alleviate the patient's pain.