NESmith
Expert
Please help. Provider did:
Lt sacroiliac injection under fluoroscopic visualization
Lt L5, S1, S2 and S3 dorasal primary ramus injection under fluoroscopic visualization
Procedure: A timeout was performed neatly prior to the procedure. The surgical site was confirmed by the anesthesiologist, operative physician, and circulating or personnel, and the patient.
With the patient having had an intravenous started and all routine monitoring intact to include blood pressure and continuous pulse oximetry, patient was placed in the prone position. Sterile meticulous prep of the entire left sacroiliac area was performed using Betadine x 3 and a sterile draping was placed.
A #22 gauge 3-1/2 spinal needle was then inserted into the inferior pole of the left sacroiliac joint and advanced to the mid joint position. This was confirmed with oblique and lateral fluoroscopic imaging. After negative aspiration, 0.5 cc of optirary non-ionic contrast was injected in the performance of a left SI joint arthrogram to ensure adquate spread of contrast beneath the joint capaule within the joint.
Ther was no vascular run off. Contrast spread beneath the joint capsule and was seen along the posterior border of the joint. For the purpose of interpretation and diagnosis, hard film copies were taken. There were no obvious bony abnormalities. A solution was then prepared containing 7 cc 0.25% bupivicaine, 12mg celestone soluspan and 2cc of preservative free normal saline. 3-4cc of the premixed solution was injected into the left joint. The needle was removed. In order to ensure dense joint blockage for diagnostic purposes the paravertebral facet nerves innervating the joints were anesthetized. A #25 guage 3-1/2 inch needle was placed at the left sacral ala and the 10 o'clock position of the S1, S2 and S3 dorsal foramen. Specifically targeting the left L5, S1, S2 and S3 medical branch nerves. After negative aspiration, 0.-0.75 cc of the pre-mixed solution was injected at each level.
Hard film copies were made documenting needle placement and the needles were removed. Allinjection sites were sterilely dressed.
The patient tolerated the procedure well and was taken to the recovery room in stable condition with no complaints and neurologic exam was unchanged. After one-half hour the patient was evaluated with respect to pain response. The patient had a preoperative pain score of 8 and postoperative pain score of 8 on a numerical pain scale. The patient was given explicit instructions for followup. pending the residual benefits of this injection we will proceed with the treatment plan accordingly.
CPT codes billed:27096-LT
77003
64450-59LT
64450-7659LT
64450-7659LT
64450-7659LT
J0702
Commerical insurance denying for documentation does not support the 64450. I am not sure that these are the correct codes. Please give me your opinion and if they are correct, why would they be denied. Thanks as always for the help
Lt sacroiliac injection under fluoroscopic visualization
Lt L5, S1, S2 and S3 dorasal primary ramus injection under fluoroscopic visualization
Procedure: A timeout was performed neatly prior to the procedure. The surgical site was confirmed by the anesthesiologist, operative physician, and circulating or personnel, and the patient.
With the patient having had an intravenous started and all routine monitoring intact to include blood pressure and continuous pulse oximetry, patient was placed in the prone position. Sterile meticulous prep of the entire left sacroiliac area was performed using Betadine x 3 and a sterile draping was placed.
A #22 gauge 3-1/2 spinal needle was then inserted into the inferior pole of the left sacroiliac joint and advanced to the mid joint position. This was confirmed with oblique and lateral fluoroscopic imaging. After negative aspiration, 0.5 cc of optirary non-ionic contrast was injected in the performance of a left SI joint arthrogram to ensure adquate spread of contrast beneath the joint capaule within the joint.
Ther was no vascular run off. Contrast spread beneath the joint capsule and was seen along the posterior border of the joint. For the purpose of interpretation and diagnosis, hard film copies were taken. There were no obvious bony abnormalities. A solution was then prepared containing 7 cc 0.25% bupivicaine, 12mg celestone soluspan and 2cc of preservative free normal saline. 3-4cc of the premixed solution was injected into the left joint. The needle was removed. In order to ensure dense joint blockage for diagnostic purposes the paravertebral facet nerves innervating the joints were anesthetized. A #25 guage 3-1/2 inch needle was placed at the left sacral ala and the 10 o'clock position of the S1, S2 and S3 dorsal foramen. Specifically targeting the left L5, S1, S2 and S3 medical branch nerves. After negative aspiration, 0.-0.75 cc of the pre-mixed solution was injected at each level.
Hard film copies were made documenting needle placement and the needles were removed. Allinjection sites were sterilely dressed.
The patient tolerated the procedure well and was taken to the recovery room in stable condition with no complaints and neurologic exam was unchanged. After one-half hour the patient was evaluated with respect to pain response. The patient had a preoperative pain score of 8 and postoperative pain score of 8 on a numerical pain scale. The patient was given explicit instructions for followup. pending the residual benefits of this injection we will proceed with the treatment plan accordingly.
CPT codes billed:27096-LT
77003
64450-59LT
64450-7659LT
64450-7659LT
64450-7659LT
J0702
Commerical insurance denying for documentation does not support the 64450. I am not sure that these are the correct codes. Please give me your opinion and if they are correct, why would they be denied. Thanks as always for the help