64622 64623
Dear Just my passion,
That was what i thought so I brought it to the attention of our coding and comp dept and they disagree. Do you know of any web site that I can get this info from to show them?
Also on the L3 L4 L5 and S1 when he documents like that medicare is only paying 2 levels and saying that his note are not sufficient for the other 2 levels which one issue may be the S1 but why are they not paying for the other? This is an example of his notes
PREOPERATIVE DIAGNOSIS:
1. LUMBAR SPONDYLOSIS.
2. LUMBAGO.
3. LUMBAR DEGENERATIVE DISC DISEASE.
4. LUMBAR FACET SYNDROME.
POST OPERATIVE DIAGNOSIS: SAME
OPERATION PERFORMED: RIGHT THERAPEUTIC SELECTIVE LUMBAR RADIOFREQUENCY THERMAL-COAGULATION (RHIZOTOMY) OF THE MEDIAN BRANCH NERVES UNDER FLUOROSCOPY GUIDANCE AT L3, L4, L5 AND S1
ANESTHESIA: VERSED 6 MG
FENTANYL 100 MCG
ANESTHESIA PROVIDER: , RN
COMPLICATIONS: NONE
HISTORY: The patient is a 59 year old female with degenerative changes in the lumbar spine with chronic persistent pain.
MEDICAL NECESSITY: The patient is 59 years old with pain that affects her day to day functional activities. She had not responded to conservative treatments including physical therapy, modified activities, analgesics, non-steroidal medications, injection therapy as well as dorsal column stimulator placement. She has had a radiofrequency rhizotomy on the left with about 30% improvement. I am going to repeat the procedure on the right and see if we can get some additive benefits. After this I will see her back in clinic for reassessment.
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This procedure is medically necessary in order to reduce the patient's pain and to restore the patient to their previous functional level.
DESCRIPTION OF PROCEDURE: The procedure was discussed with the patient, questions were answered and consent was obtained. The patient was taken to the operating room and placed in the prone position on the fluoroscopy table. Pressure points were padded. The patient is prepped with a sterile cutaneous antiseptic solution and sterile drapes applied. Monitors are applied and vital signs are stable.
After vital signs were checked, physician directed intravenous anesthesia was initiated per my orders and titrated to effect.
With fluoroscopic guidance, the right L3 vertebral body is visualized. The camera is rotated obliquely to obtain the best visualization of the junction of the transverse process with the vertebral body on the right. The tissues were then infiltrated above the target site with 5 ml of 1% Lidocaine. A 20 gauge radiofrequency needle with a 5 mm active tip is then placed through the skin and directed until contact is made with the junction of the transverse process and vertebral body. This would be at approximately the 11 o'clock position of the pedicle on the left and the 1 o'clock position of the pedicle on the right. A lateral view is checked to ensure the needle tip is not near the neuroforamen at each level. Sensory testing was then completed with 50 hertz up to one volt. Motor testing was also verified with 2 hertz up to 3 volts. There is no sensory motor involvement in the lower extremities. The area is then anesthetized with 5 ml of 0.5% Marcaine. Needle position is then re-verified with both oblique and lateral view. A lesion is made for 60 seconds at 80 degrees centigrade. The needle is then moved slightly and a second lesion is made for 60 seconds at 80 degrees centigrade. The same technique is then used to make lesions at the right L4 and L5 levels.
The sacral ala is visualized. Again the camera is rotated slightly oblique to help visualize the best approach to that level. The tissues were infiltrated with a 10:1 mixture of 5 ml of 1% Lidocaine and 8.4% Sodium Bicarb. A 20 gauge radiofrequency needle with a 5 mm active tip is again placed through the skin and directed until contact is made with the sacral ala. Again the appropriate motor and sensory testing is performed. A lateral view is checked to ensure that we are not near a nerve root. There is no motor or sensory stimulation in the lower extremity. The area is then anesthetized with 2 ml of 1% Lidocaine and 1 ml of 0.5% Bupivacaine. Two lesions are made for 60 seconds at 80 degrees centigrade.
The needle is then repositioned to approximately the 12 o'clock position of the S1 foramen. After motor and sensory testing, the area is infiltrated with 2 ml of 1% Lidocaine and 1 ml of 0.5% Bupivacaine. Two lesions are made for 60 seconds at 80 degrees centigrade.
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04/15/11
The patient tolerated the procedure well. There were no complications. The patient was taken to the recovery room where vital signs were monitored. The patient is discharged home in the care of another adult. Prior to discharge, the patient was instructed to call or return to the hospital for any questions or concerns about the procedure. The patient was informed that they may have a flare-up of their symptoms in the next 1-2 weeks and this will be addressed with their discharge instructions. The patient is scheduled for a repeat/follow up in 1-2 weeks.
