ortho1991
Guru
Hi,
I hope someone can advise me on this. Op-note in short. Proc. done at ASC
Using fluoroscopic guidance, I visualized the L5 vertebra body. The superior endplate of the vertebral body was brought into sharp view. The target site was the 6 O'clock position of the L5 pedicle. Subcutaneous 1% lidocane was injectied at the target site. Then, a 22 gauge SMK-type needle was directed toward this target site. Depth was gauged on AP and lateral views. After ideal position, testing was carried out. Sensory was at 0.3 MHz and motor testing was at 0.5 Hz Two rounds of pulsed radiofrequency at 40 degrees and carried out for 2 min. Then, using manual control, I increased the heat at the patient's level of tolerance. This was at 45 degrees. This was held at approximately 30 seconds. Thereafter, another round of puled radiofrequency was done at 40 degrees for 2 min.
Next, radiopaque dye was injected which showed no intravascular sprad, and uptake of the dye, folling the nerve root as well as to the epidural space. A total of 40mg Kenalog and 1cc of 1% lidocaine was injected. The needle was withdraw.
Physician bills 64635 and 64483. Can we bill both? Our local Medicare carrier denied 64483 as incl.
Any advice or suggestions will be appreciated
Thank you
I hope someone can advise me on this. Op-note in short. Proc. done at ASC
Using fluoroscopic guidance, I visualized the L5 vertebra body. The superior endplate of the vertebral body was brought into sharp view. The target site was the 6 O'clock position of the L5 pedicle. Subcutaneous 1% lidocane was injectied at the target site. Then, a 22 gauge SMK-type needle was directed toward this target site. Depth was gauged on AP and lateral views. After ideal position, testing was carried out. Sensory was at 0.3 MHz and motor testing was at 0.5 Hz Two rounds of pulsed radiofrequency at 40 degrees and carried out for 2 min. Then, using manual control, I increased the heat at the patient's level of tolerance. This was at 45 degrees. This was held at approximately 30 seconds. Thereafter, another round of puled radiofrequency was done at 40 degrees for 2 min.
Next, radiopaque dye was injected which showed no intravascular sprad, and uptake of the dye, folling the nerve root as well as to the epidural space. A total of 40mg Kenalog and 1cc of 1% lidocaine was injected. The needle was withdraw.
Physician bills 64635 and 64483. Can we bill both? Our local Medicare carrier denied 64483 as incl.
Any advice or suggestions will be appreciated
Thank you