First place -- I am new to pain management -like really new
My provider has coded this note as 64493,LT-64494,LT-64495,LT. He does not address the dorsal block. Insurance (UHC medicare advantage) paid 93 and 94 but not the 95 (This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.)
I've looked these up but an getting very confused. He states his coding is "good"
I just need some direction
Operative Details:
Operative Details:
· Operative Details
PreOp Diagnosis: Lumbar Spondylosis without Myelopathy
Post-Op Diagnosis: Lumbar Spondylosis without Myelopathy
Procedure: Left Diagnostic L2, 3, 4 Medial Branch and L5 Dorsal Ramus Block
Attending: Dr. Jameson
Injectate: 4cc 0.25% bupivacaine
History reviewed with patient. After rediscussion of procedure with the patient, including its risks, benefits and outcome data, possibility of no effect and increased pain, informed consent was obtained verbally and in writing and decision was made to proceed. Patient denies antibiotics, history of bleeding tendencies or evidence of recent infections.
Patient was placed on the fluoroscopy table in the prone position. The back was prepped and draped in the usual sterile fashion and sterile technique was adhered to during the entire procedure. Fluoroscopy was utilized to confirm needle and injectate localization. Upper vertebral body was identified in the AP view and then a slight oblique view was obtained to optimize visualization of junction of superior articular process and transverse process.
L2, 3, 4 medial branches performed simultaneously. Using fluoroscopy the superior border of the transverse process at its most medial aspect was identified and infiltrated with 1% lidocaine using a 25G needle. A 25G 3.5" spinal needle was then advanced incrementally under radiographic guidance to the superior border of the transverse process at its most medial aspect and bevels turned caudad.
L5 dorsal ramus targeted by placing the needle at the superomedial junction border of the sacral ala.
Fluoroscopy views were obtained to confirm the needle tip to be at the proper depth and not encroaching into the respective foramen. Injectate was given (1cc per level). There was no evidence of IV or CSF placement, or paresthesias.
The needles were removed, patient's back was washed, dried and dressing was applied. Patient tolerated the procedure well without complications.
My provider has coded this note as 64493,LT-64494,LT-64495,LT. He does not address the dorsal block. Insurance (UHC medicare advantage) paid 93 and 94 but not the 95 (This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.)
I've looked these up but an getting very confused. He states his coding is "good"
I just need some direction
Operative Details:
Operative Details:
· Operative Details
PreOp Diagnosis: Lumbar Spondylosis without Myelopathy
Post-Op Diagnosis: Lumbar Spondylosis without Myelopathy
Procedure: Left Diagnostic L2, 3, 4 Medial Branch and L5 Dorsal Ramus Block
Attending: Dr. Jameson
Injectate: 4cc 0.25% bupivacaine
History reviewed with patient. After rediscussion of procedure with the patient, including its risks, benefits and outcome data, possibility of no effect and increased pain, informed consent was obtained verbally and in writing and decision was made to proceed. Patient denies antibiotics, history of bleeding tendencies or evidence of recent infections.
Patient was placed on the fluoroscopy table in the prone position. The back was prepped and draped in the usual sterile fashion and sterile technique was adhered to during the entire procedure. Fluoroscopy was utilized to confirm needle and injectate localization. Upper vertebral body was identified in the AP view and then a slight oblique view was obtained to optimize visualization of junction of superior articular process and transverse process.
L2, 3, 4 medial branches performed simultaneously. Using fluoroscopy the superior border of the transverse process at its most medial aspect was identified and infiltrated with 1% lidocaine using a 25G needle. A 25G 3.5" spinal needle was then advanced incrementally under radiographic guidance to the superior border of the transverse process at its most medial aspect and bevels turned caudad.
L5 dorsal ramus targeted by placing the needle at the superomedial junction border of the sacral ala.
Fluoroscopy views were obtained to confirm the needle tip to be at the proper depth and not encroaching into the respective foramen. Injectate was given (1cc per level). There was no evidence of IV or CSF placement, or paresthesias.
The needles were removed, patient's back was washed, dried and dressing was applied. Patient tolerated the procedure well without complications.
