I need some help please. The following is a procedure note and I would like some opinions on how it should be coded. The biggest question I have is due the use of a stimulating catheter, should it be coded as a nerve block or is it something else?
Pudendal Nerve Block for pudendal nerve entrapment neuropathy
IV was started on the right forearm with 22 g IV angiocatheter. The patient was transferred to the fluoro procedure room. The patient was placed in Left lateral decubitus. The right ischial spine was identified under fluoroscopy. The skin overlying the area to be injected was prepped with Betadine. The injection site was anesthetized with 3 cc of 1% lidocaine. Under real time USG guidance, a 18 G Touhy needle was advanced till it passed the sacrotuberous and sacrospinous ligaments towards the ischial spine. Needle depth and position were checked intermittently with fluoroscopic guidance. Once appropriate needle position was confirmed a 20 G stimulating catheter was placed and position confirmed to be in close proximity to the ischial spine. 1 cc of 180 mg/dl Omnipaque was injected after negative aspiration for heme to confirm non vascular placement of the catheter. The catheter was then secured and the patient transported to the recovery area. The catheter was then stimulated at 2 Hz frequency with incremental current till the patient reported pain relief which she did at a current of 0.6 mA. We left the stimulation on and had the patient sit up, walk and do activities that cause her discomfort and the patient was able to do all of these activities without much discomfort while the stimulation was ongoing. The stimulator was then stopped and the patient complained of return of pain in about 5 minutes. Then incremental injections of local anesthetic were made. We first injected 2 ml of 0.5 % ropivacaine and observed her for 5 minutes. She did not have much pain relief. Then an additional 4 ml was injected and the patient began to have some relief of her symptoms. After a period of another 5 minutes, and additional 6 cc of local anesthetic and 10 mg of Dexamethasone was injected. Patient was then monitored for another 15 minutes and then discharged home in stable condition.
Thanks.
Kim
Pudendal Nerve Block for pudendal nerve entrapment neuropathy
IV was started on the right forearm with 22 g IV angiocatheter. The patient was transferred to the fluoro procedure room. The patient was placed in Left lateral decubitus. The right ischial spine was identified under fluoroscopy. The skin overlying the area to be injected was prepped with Betadine. The injection site was anesthetized with 3 cc of 1% lidocaine. Under real time USG guidance, a 18 G Touhy needle was advanced till it passed the sacrotuberous and sacrospinous ligaments towards the ischial spine. Needle depth and position were checked intermittently with fluoroscopic guidance. Once appropriate needle position was confirmed a 20 G stimulating catheter was placed and position confirmed to be in close proximity to the ischial spine. 1 cc of 180 mg/dl Omnipaque was injected after negative aspiration for heme to confirm non vascular placement of the catheter. The catheter was then secured and the patient transported to the recovery area. The catheter was then stimulated at 2 Hz frequency with incremental current till the patient reported pain relief which she did at a current of 0.6 mA. We left the stimulation on and had the patient sit up, walk and do activities that cause her discomfort and the patient was able to do all of these activities without much discomfort while the stimulation was ongoing. The stimulator was then stopped and the patient complained of return of pain in about 5 minutes. Then incremental injections of local anesthetic were made. We first injected 2 ml of 0.5 % ropivacaine and observed her for 5 minutes. She did not have much pain relief. Then an additional 4 ml was injected and the patient began to have some relief of her symptoms. After a period of another 5 minutes, and additional 6 cc of local anesthetic and 10 mg of Dexamethasone was injected. Patient was then monitored for another 15 minutes and then discharged home in stable condition.
Thanks.
Kim