574coding
Guru
Hi,
Would someone be able to explain the difference between the different types of Destructions by Neurolytic Agent or somewhere I can get this info? I have been searching, but have not found any concrete answers.
What is pulsed, non-pulsed, cool, thermal, electrical, and chemical destructions?
Does it depend on the needle or the radiofrequency pulsed generator that was used or the degrees centigrade / Celsius.
I am finding it difficult to extract the type from the documentation. Should I be coding under the 64600-64681 or using the unlisted code 64999.
Here is a few examples from the report:
Testing for motor stimulation was performed at each level once all the cannulae were in position. Absence of lower extremity motor fasciculation was noted at 4 volts at 2 Hz stimulation during testing of the L3, L4 and L5 medial branch nerves, respectively. Following this affirmation of negative motor stimulation, negative aspiration for heme or CSF was noted at each level. Next, 1.0 ml of a solution containing 1 mg dexmethasone and 0.25% bupivicaine was injected at each site. After a 30 second delay, lesions were performed at a temperature of 80 degrees centigrade for a total of 90 seconds. After the needle tips had cooled to 45 degrees centigrade they were sequentially removed At the end of the procedure it was noted that the patient could purposefully move all four extremities. Sterile bandages were placed over the puncture sites.
I coded this one under the 62635 and 64636 codes.
and
The patient was placed in the prone position. She was prepped and draped in the usual sterile fashion. A fluoroscopy machine was used to isolate the bony anatomy. The overlying skin was anesthetized with 2 mls of 0.5% Lidocaine at each level. 10 cm radiofrequency needles were advanced under fluoroscopic guidance at each level indicated, to the final position. For the dorsal ramus of L5, the needed tip was placed at the junction of sacral ala and superior articular process of S1. For the lateral branch of S1, S2, and S3, S4 the simplicity catheter was placed in between the foramen and the SIjoint. AP and lateral views confirmed needled placement and needle placement motor testing was begun. Motor interrogation revealed no distal myotomal stimulation. Radiofrequency ablation was initiated at 80 degrees Celsius for 90 seconds. A total of 20mg of Kenalog and 9 cc of .25 Bupivacaine was divided and injected in each level. All needles were withdrawn.
This one I was coding under 64999...
Thank you so much for any help!
Would someone be able to explain the difference between the different types of Destructions by Neurolytic Agent or somewhere I can get this info? I have been searching, but have not found any concrete answers.
What is pulsed, non-pulsed, cool, thermal, electrical, and chemical destructions?
Does it depend on the needle or the radiofrequency pulsed generator that was used or the degrees centigrade / Celsius.
I am finding it difficult to extract the type from the documentation. Should I be coding under the 64600-64681 or using the unlisted code 64999.
Here is a few examples from the report:
Testing for motor stimulation was performed at each level once all the cannulae were in position. Absence of lower extremity motor fasciculation was noted at 4 volts at 2 Hz stimulation during testing of the L3, L4 and L5 medial branch nerves, respectively. Following this affirmation of negative motor stimulation, negative aspiration for heme or CSF was noted at each level. Next, 1.0 ml of a solution containing 1 mg dexmethasone and 0.25% bupivicaine was injected at each site. After a 30 second delay, lesions were performed at a temperature of 80 degrees centigrade for a total of 90 seconds. After the needle tips had cooled to 45 degrees centigrade they were sequentially removed At the end of the procedure it was noted that the patient could purposefully move all four extremities. Sterile bandages were placed over the puncture sites.
I coded this one under the 62635 and 64636 codes.
and
The patient was placed in the prone position. She was prepped and draped in the usual sterile fashion. A fluoroscopy machine was used to isolate the bony anatomy. The overlying skin was anesthetized with 2 mls of 0.5% Lidocaine at each level. 10 cm radiofrequency needles were advanced under fluoroscopic guidance at each level indicated, to the final position. For the dorsal ramus of L5, the needed tip was placed at the junction of sacral ala and superior articular process of S1. For the lateral branch of S1, S2, and S3, S4 the simplicity catheter was placed in between the foramen and the SIjoint. AP and lateral views confirmed needled placement and needle placement motor testing was begun. Motor interrogation revealed no distal myotomal stimulation. Radiofrequency ablation was initiated at 80 degrees Celsius for 90 seconds. A total of 20mg of Kenalog and 9 cc of .25 Bupivacaine was divided and injected in each level. All needles were withdrawn.
This one I was coding under 64999...
Thank you so much for any help!