annieledesma
Guest
I need help with coding this. I think it would be 64633x1 and 64634x2.
Pre Procedure Diagnosis: mid back pain/posterior element pain secondary to facet disease
Post Procedure Diagnosis: Same
Procedure: 1. Radiofrequency Ablation of thoracic medial branches at Right
T9, T10, T11
2. Fluoroscopic Guidance and needle localization
Procedure in Detail:
After informing the patient of the risk and benefits of the procedure including infection, bleeding and increased pain as well as possible spinal injury, the patient was brought to the operating room and placed in a prone position.
The patient was given moderate IV sedation/MAC per anesthesia/CRNA.
After prepping and draping the patient's skin in a sterile fashion, the patient's spine was studied under fluoroscopy and after injecting the skin at the intended needle trajectory with a 1% lidocaine solution, a set of 20 gauge 10mm active tip RFK needle was advanced toward the junction between the superior articular process and transverse process of right T9, T10 & T11 levels using standard techniques as set forth by the ISIS and ASIPP guidelines. After contacting the periosteum, each of the needles were further adjusted for correct placement by sliding the needle around/across the groove/junction of each of the joint levels at the correct anatomic location of the traversing medial branch.
At this point, each of the medial branches was further tested for correct needle placement by stimulating each of the nerves with standard sensory and motor signals using standard algorithm.
Patient had appropriate sensory paresthesia locally at below 1volt 50 Hz stimulation and there was no distal motor root effect at upto 1.5volts at 2Hz stimulation.
After above, each of the medial branches was blocked with 1 cc volume of injectant , which was a mixture of 6 mg with betamethasone in a 6 cc volume of 0.5% bupivacaine solution. After this, each nerve was lesioned multiple times at 85 deg Celsius at 90second interval, by moving the RFK needle slightly above and below each of the lesion site.
The patient tolerated the procedure well and was discharged to PACU and reevaluated before being discharged home with follow up instructions/Post procedure instructions. The patient was again reminded of possible flareup pain in the first 1-2 weeks.
Pre Procedure Diagnosis: mid back pain/posterior element pain secondary to facet disease
Post Procedure Diagnosis: Same
Procedure: 1. Radiofrequency Ablation of thoracic medial branches at Right
T9, T10, T11
2. Fluoroscopic Guidance and needle localization
Procedure in Detail:
After informing the patient of the risk and benefits of the procedure including infection, bleeding and increased pain as well as possible spinal injury, the patient was brought to the operating room and placed in a prone position.
The patient was given moderate IV sedation/MAC per anesthesia/CRNA.
After prepping and draping the patient's skin in a sterile fashion, the patient's spine was studied under fluoroscopy and after injecting the skin at the intended needle trajectory with a 1% lidocaine solution, a set of 20 gauge 10mm active tip RFK needle was advanced toward the junction between the superior articular process and transverse process of right T9, T10 & T11 levels using standard techniques as set forth by the ISIS and ASIPP guidelines. After contacting the periosteum, each of the needles were further adjusted for correct placement by sliding the needle around/across the groove/junction of each of the joint levels at the correct anatomic location of the traversing medial branch.
At this point, each of the medial branches was further tested for correct needle placement by stimulating each of the nerves with standard sensory and motor signals using standard algorithm.
Patient had appropriate sensory paresthesia locally at below 1volt 50 Hz stimulation and there was no distal motor root effect at upto 1.5volts at 2Hz stimulation.
After above, each of the medial branches was blocked with 1 cc volume of injectant , which was a mixture of 6 mg with betamethasone in a 6 cc volume of 0.5% bupivacaine solution. After this, each nerve was lesioned multiple times at 85 deg Celsius at 90second interval, by moving the RFK needle slightly above and below each of the lesion site.
The patient tolerated the procedure well and was discharged to PACU and reevaluated before being discharged home with follow up instructions/Post procedure instructions. The patient was again reminded of possible flareup pain in the first 1-2 weeks.