Wiki Help coding lumbar and sacral RFA

[cherylbr]

PLEASE HELP WITH THE CORRECT CODING OF THIS OP NOTE:

Procedure performed: Radiofrequency ablation right L4, L5 medial branches, S1, S2, S3 lateral branches.

Description of Procedure: Ipsilateral oblique views were used to visualize the junction of the right L4 transverse process with the right superior articular process. A level was anesthetized and a spinal needle of the above size, gauge, and length were directed towards the junction. It was advanced under oblique fluoroscopy. Then, attention was turned to the sacral ala in an AP view. The level was anesthetized and a similar needle was directed toward the sacral ala. Then, ipsilateral oblique views were utilized and levels were anesthetized with a spinal needle directed towards the upper outer aspects of the bone bordering the neural foramen at approximately 2 o'clock view. Motor stimulation was performed at all levels which did not reproduce or cause any right leg movements. Then, radiofrequency ablation was performed at the above 5 levels at 80 degrees Celsius for 90 seconds.

 

[nickelclaw]

[64635, 64636]

These procedures are performed to treat chronic lumbar or sacral back pain. The affected lumbar or sacral spinal nerve is destroyed using chemical, thermal, electrical, or nonpulsed radiofrequency techniques, which may be used independently or in combination. These procedures are designed to destroy the specific site(s) in the nerve root that produces the pain while leaving sensation intact. Generally, intravenous conscious sedation is used during the initial phase of the procedure so that the patient can assist the physician in identifying the site of pain and the correct placement of the neurolytic agent; local anesthesia is administered during the destruction phase of the procedure. Using fluoroscopic guidance, a needle is inserted into the affected nerve root. An electrode is inserted through the needle and a mild electrical current is passed through the electrode. The current produces a tingling sensation at a site on the nerve. The electrode is manipulated until the tingling sensation is felt at the same site as the pain, after which a local anesthetic is administered and a neurolytic agent applied. Chemical destruction involves injection of a neurolytic substance (e.g., alcohol, phenol, glycerol) into the affected nerve root. Thermal techniques use heat ≥ 80 degrees Celsius. Electrical techniques use an electrical current. Nonpulsed radiofrequency, also referred to as radiofrequency rhizotomy, uses a solar or microwave current. Report 64635 for destruction of a single facet joint at the lumbar or sacral spine level and 64636 for destruction of each additional lumbar or sacral spinal joint.