64581, 77002 & 95972 are the codes I got
Any help?
DESCRIPTION OF PROCEDURE: The patient was properly identified and placed in the prone position per operating room protocol. General endotracheal anesthesia was administered. Pillows were placed under the lower abdomen to flatten the sacrum and
under the shins to allow the toes to dangle freely. The patient was prepped in the usual sterile fashion utilizing
ChloraPrep skin solution. The C-arm was draped and moved into the AP position to provide fluoroscopic mapping of the sacral
region which included marking out midline of the sacrum, SI joint, sciatic notches, medial foraminal borders, and sacral
foramina. The C-arm was moved to a lateral position, imaging the area from the sacral promontory to the coccyx. Local
injection of 0.5% Marcaine with epinephrine was administered. A 3-inch size foramen needle was then introduced approximately 2 cm above the sciatic notch and 2 cm lateral to the sacral midline, feeling for the foraminal margin until
the S3 foramen was identified and penetrated on the left side. The depth of the needle was confirmed and adjusted
fluoroscopically. Proper needle placement was confirmed by fluoroscopic landmarks, direct observation of lifting of the
perineum, and observation of plantarflexion of the great toe utilizing the external test stimulator. The foramen needle stylet was then removed and a directional guide was placed and confirmed fluoroscopically. The foramen needle was removed. An incision was made peripherally to the directional guide through the fascial layer. The lead introducer sheath with dilator was placed over the directional guide and directed into the foramen utilizing the radiopaque marker of the lead introducer, ensuring that it
did not extend beyond the anterior edge of the sacrum. The dilator was unlocked and removed, along with the directional
guide. The lead was then placed through the introducer sheath to the first white line and positioned and checked fluoroscopically. The lead was then further introduced until 3 electrodes were visible below the sacrum and each electrode was tested for location of patient sensation, visualization of bellows, and plantarflexion of the great toe. After satisfactory positioning was confirmed, the introducer sheath was retracted under continuous fluoroscopy, deploying lead tines into the perisacral tissues. Further incision was made into the subcutaneous tissues posterior to the iliac crest and lateral to the sacrum on the contralateral side of the gluteus. Blunt dissection was continued until the gluteal fascia was identified and hemostasis was achieved. A tunneling tool with a straw was placed from the lead access site subcutaneously to the incised pocket site. The tunneling tool was removed and the
lead was fed through the straw and pulled out the pocket site. The lead was cleansed of bodily fluids, dried, and protective boot was placed over the lead. The lead was inserted into the temporary percutaneous extension and the metal bands were aligned. The 4 set screws were tightened with a hex wrench and the boot was pushed over the connection and secured with 2-0 Prolene sutures on the boot grooves on either side of the connection. A tunnel was then made subcutaneously and exited to a
puncture site above the contralateral buttock. Percutaneous extension was placed through the straw and exposed and
connected to the twist-lock gray cable. The wounds were then irrigated with antibiotic solution and water and closed with
4-0 Monocryl subcuticular stitches and Steri-Strips. Counts were correct. Steri-Strips and gauze, 4 x 4's were placed
____ the incisions. Tegaderm was placed to cover the incisions and gauze was placed under the twist-lock cable
connector. The estimated blood loss was zero. The patient was transferred to the PACU in satisfactory condition. Using the
external test stimulator, the patient was programmed to the electrode of optimal sensation and given instruction on
utilizing the external test stimulator prior to discharge. A diary will be kept until return appointment in my office to discuss results of the test stimulation.
Any help?
DESCRIPTION OF PROCEDURE: The patient was properly identified and placed in the prone position per operating room protocol. General endotracheal anesthesia was administered. Pillows were placed under the lower abdomen to flatten the sacrum and
under the shins to allow the toes to dangle freely. The patient was prepped in the usual sterile fashion utilizing
ChloraPrep skin solution. The C-arm was draped and moved into the AP position to provide fluoroscopic mapping of the sacral
region which included marking out midline of the sacrum, SI joint, sciatic notches, medial foraminal borders, and sacral
foramina. The C-arm was moved to a lateral position, imaging the area from the sacral promontory to the coccyx. Local
injection of 0.5% Marcaine with epinephrine was administered. A 3-inch size foramen needle was then introduced approximately 2 cm above the sciatic notch and 2 cm lateral to the sacral midline, feeling for the foraminal margin until
the S3 foramen was identified and penetrated on the left side. The depth of the needle was confirmed and adjusted
fluoroscopically. Proper needle placement was confirmed by fluoroscopic landmarks, direct observation of lifting of the
perineum, and observation of plantarflexion of the great toe utilizing the external test stimulator. The foramen needle stylet was then removed and a directional guide was placed and confirmed fluoroscopically. The foramen needle was removed. An incision was made peripherally to the directional guide through the fascial layer. The lead introducer sheath with dilator was placed over the directional guide and directed into the foramen utilizing the radiopaque marker of the lead introducer, ensuring that it
did not extend beyond the anterior edge of the sacrum. The dilator was unlocked and removed, along with the directional
guide. The lead was then placed through the introducer sheath to the first white line and positioned and checked fluoroscopically. The lead was then further introduced until 3 electrodes were visible below the sacrum and each electrode was tested for location of patient sensation, visualization of bellows, and plantarflexion of the great toe. After satisfactory positioning was confirmed, the introducer sheath was retracted under continuous fluoroscopy, deploying lead tines into the perisacral tissues. Further incision was made into the subcutaneous tissues posterior to the iliac crest and lateral to the sacrum on the contralateral side of the gluteus. Blunt dissection was continued until the gluteal fascia was identified and hemostasis was achieved. A tunneling tool with a straw was placed from the lead access site subcutaneously to the incised pocket site. The tunneling tool was removed and the
lead was fed through the straw and pulled out the pocket site. The lead was cleansed of bodily fluids, dried, and protective boot was placed over the lead. The lead was inserted into the temporary percutaneous extension and the metal bands were aligned. The 4 set screws were tightened with a hex wrench and the boot was pushed over the connection and secured with 2-0 Prolene sutures on the boot grooves on either side of the connection. A tunnel was then made subcutaneously and exited to a
puncture site above the contralateral buttock. Percutaneous extension was placed through the straw and exposed and
connected to the twist-lock gray cable. The wounds were then irrigated with antibiotic solution and water and closed with
4-0 Monocryl subcuticular stitches and Steri-Strips. Counts were correct. Steri-Strips and gauze, 4 x 4's were placed
____ the incisions. Tegaderm was placed to cover the incisions and gauze was placed under the twist-lock cable
connector. The estimated blood loss was zero. The patient was transferred to the PACU in satisfactory condition. Using the
external test stimulator, the patient was programmed to the electrode of optimal sensation and given instruction on
utilizing the external test stimulator prior to discharge. A diary will be kept until return appointment in my office to discuss results of the test stimulation.