kitkatcoder
Networker
Hello,
I see that you are an expert at pain management and wanted to pick your brain.
Neurolytic solution was injected by cath but cath was removed… so I did not use 62318 or 62311
Would it be appropriate to use 62282 on case..Office and I are going back and forth on this and they are wanting to use 62318…Any help I would greatly appreciate.
PREOPERATIVE DIAGNOSES:
1. Low back pain.
2. Lumbar radicular pain.
POSTOPERATIVE DIAGNOSES:
1. Low back pain.
2. Lumbar radicular pain.
OPERATIONS PERFORMED:
1. Fluoroscopic evaluation of lumbar spine.
2. Diagnostic lumbar epidurogram.
3. Anesthetic injection per epidural catheter.
4. Steroid injection per epidural catheter.
5. Injection of hypertonic saline.
ANESTHESIA: MAC with IV sedation.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
INDICATIONS: is a 75-year-old male who has got significant pain in his low back region and pain in his left lower extremity. He has undergone conservative measures recently with persistent pain. The risks and benefits of the procedure were explained to the patient. The patient agrees to proceed with the procedure.
DESCRIPTION OF PROCEDURE: The patient was taken to the OR #3 and placed in a prone position. Pressure points were checked and padded. Monitoring was provided, which included EKG, blood pressure, and pulse oximetry.
Lumbosacral region was prepped and draped in a sterile fashion. Sacral hiatus was identified in lateral fluoroscopic view. Left paramedian insertion site was marked. After adequate IV sedation, the skin over the insertion site was infiltrated with 1% lidocaine.
Next, a 16-gauge RK needle was advanced under fluoroscopic direction until it passed in the sacral hiatus. The needle-tip position was confirmed via AP and lateral fluoroscopic views. Next, an epidural catheter was advanced in a ventral-to-cephalad direction and placed at the mid L5 vertebral body region at the midline. The catheter was confirmed via AP and lateral fluoroscopic views. Next, 10 mL of Omnipaque contrast was used to perform diagnostic lumbar epidurogram. There was very minimal spread of the dye in a cephalad direction. With additional fluid injected, there was some flow of dye to the L4-L5 level and none above that level. Next, 3 mL of 0.25% Marcaine was given as a test dose. After a few minutes, there was no evidence of intrathecal, intravascular, or subdural spread of local anesthetic. Next, 7 mL of 0.25% Marcaine mixed with 40 mg of Kenalog was injected slowly with frequent negative aspiration. The patient tolerated the procedure well with stable vital signs followed by injection of 7 mL of 10% sodium chloride. Catheter was then flushed with 1 mL of 1% lidocaine. The catheter and needle were then withdrawn with the tip intact. Sterile Band-Aid was applied at the catheter insertion site. The patient was transported to the PACU in stable condition. After few minutes in the recovery room, vital signs were stable. There was no evidence of any motor blockade to lower extremities. The patient remained in the monitored setting prior to discharge to home.
I see that you are an expert at pain management and wanted to pick your brain.
Neurolytic solution was injected by cath but cath was removed… so I did not use 62318 or 62311
Would it be appropriate to use 62282 on case..Office and I are going back and forth on this and they are wanting to use 62318…Any help I would greatly appreciate.
PREOPERATIVE DIAGNOSES:
1. Low back pain.
2. Lumbar radicular pain.
POSTOPERATIVE DIAGNOSES:
1. Low back pain.
2. Lumbar radicular pain.
OPERATIONS PERFORMED:
1. Fluoroscopic evaluation of lumbar spine.
2. Diagnostic lumbar epidurogram.
3. Anesthetic injection per epidural catheter.
4. Steroid injection per epidural catheter.
5. Injection of hypertonic saline.
ANESTHESIA: MAC with IV sedation.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
INDICATIONS: is a 75-year-old male who has got significant pain in his low back region and pain in his left lower extremity. He has undergone conservative measures recently with persistent pain. The risks and benefits of the procedure were explained to the patient. The patient agrees to proceed with the procedure.
DESCRIPTION OF PROCEDURE: The patient was taken to the OR #3 and placed in a prone position. Pressure points were checked and padded. Monitoring was provided, which included EKG, blood pressure, and pulse oximetry.
Lumbosacral region was prepped and draped in a sterile fashion. Sacral hiatus was identified in lateral fluoroscopic view. Left paramedian insertion site was marked. After adequate IV sedation, the skin over the insertion site was infiltrated with 1% lidocaine.
Next, a 16-gauge RK needle was advanced under fluoroscopic direction until it passed in the sacral hiatus. The needle-tip position was confirmed via AP and lateral fluoroscopic views. Next, an epidural catheter was advanced in a ventral-to-cephalad direction and placed at the mid L5 vertebral body region at the midline. The catheter was confirmed via AP and lateral fluoroscopic views. Next, 10 mL of Omnipaque contrast was used to perform diagnostic lumbar epidurogram. There was very minimal spread of the dye in a cephalad direction. With additional fluid injected, there was some flow of dye to the L4-L5 level and none above that level. Next, 3 mL of 0.25% Marcaine was given as a test dose. After a few minutes, there was no evidence of intrathecal, intravascular, or subdural spread of local anesthetic. Next, 7 mL of 0.25% Marcaine mixed with 40 mg of Kenalog was injected slowly with frequent negative aspiration. The patient tolerated the procedure well with stable vital signs followed by injection of 7 mL of 10% sodium chloride. Catheter was then flushed with 1 mL of 1% lidocaine. The catheter and needle were then withdrawn with the tip intact. Sterile Band-Aid was applied at the catheter insertion site. The patient was transported to the PACU in stable condition. After few minutes in the recovery room, vital signs were stable. There was no evidence of any motor blockade to lower extremities. The patient remained in the monitored setting prior to discharge to home.
