beatet66
Contributor
Hello,
I need some help in determining if a denial for a RFA procedure is correct, we billed 64635 and 64636x2. We are told the following :"The procedure note documents RFA at the L3/4 level which only blocks one half of the facet joint at that level, therefore it does not equal a complete joint block. The note did not specify the exact medial branch nerves."
I would greatly appreciate if someone could look at the below op note and let me know if it supports three levels or only two.
Thank you!
Procedure: Radiofrequency Ablation of the Medial Branch Nerves Left , L3/4,
L4/5, and L5/S1 64635, 64636 X 2
Fluoroscopy
After performing a brief physical exam and reconfirming the surgical site, the
patient was taken to the procedure suite and placed prone on the operating room table, non invasive monitors were placed, vital signs were verified. IV access was obtained and an intravenous balanced salt solution was infused during the entire procedure.Sedation was provided under constant monitoring for ventilation, cardiovascular hemodynamics, and oxygenation . Medications used to provide sedation were Propofol, intravenous.
Documentation of the medication used for sedation was under taken on separate charting.
Fluoroscopic evaluation of the lumbar region was under taken. Identification of
the appropriate vertebral levels were identified and skin markings were placed. Area was prepped and draped in a sterile fashion with betadine on 3 separate occasions. Sterile towels were placed. The fluoroscopic image was obtained in an AP view and identification of the vertebral body was verified. A total of 5 vertebral bodies were identified. The image was then rotated to the Left and the L3/4 pedicle was placed into focus until and appropriate view of the " Scottie Dog" image was obtained and the facet joint visualization was maximized. Just lateral to the pedicle was identified correlating to
the "eye of the Scottie dog", groove along which the medial branch nerve travels. 5 cc's of 1 % lidocaine was injected in the subcutaneous tissue using a 25 ga 1 ? inch needle. At the L3/4 on the Left a 22 ga radiofrequency needle was placed with gentle manipulation under fluoroscopic guidance. Verification of needle placement was obtained and copy of which was placed on patients record and saved on the hard drive of the fluoroscopic
machine, Zheim Exposcop. After confirmation of needle placement over the appropriate location, eye of the Scottie dog, a total solution containing 1 cc of 0.5% bupivacaine and 10 mg of depo medrol solution was injected at each level respectively for a total of 30 mg of methylprednisolone, the residual 10 mg in the vial was disposed of appropriately.
Radiofrequency lesions were performed in the Direct burn mode after confirmation of impedance, negative motor response to 3mv and a positive sensory response at appropriate levels prior to lessoning. Recordings of the appropriate impedance, sensory and motor values were placed on the patients permanent record on a separate radiofrequency sheet. Radiofrequency lesions were performed for 90 seconds at a temperature of 80 degrees celsius. The needle was then removed and the procedure was
repeated in the exact same dimensions above at the L3/4 to L5/S1 levels inclusive. A total of 3 levels were performed. Needles were removed and fluoroscopic images were obtained and saved on the machines hard drive and a copy of which was placed on the patients permanent office record. Patient was alert to verbal and tactile stimuli during the entire procedure.
I need some help in determining if a denial for a RFA procedure is correct, we billed 64635 and 64636x2. We are told the following :"The procedure note documents RFA at the L3/4 level which only blocks one half of the facet joint at that level, therefore it does not equal a complete joint block. The note did not specify the exact medial branch nerves."
I would greatly appreciate if someone could look at the below op note and let me know if it supports three levels or only two.
Thank you!
Procedure: Radiofrequency Ablation of the Medial Branch Nerves Left , L3/4,
L4/5, and L5/S1 64635, 64636 X 2
Fluoroscopy
After performing a brief physical exam and reconfirming the surgical site, the
patient was taken to the procedure suite and placed prone on the operating room table, non invasive monitors were placed, vital signs were verified. IV access was obtained and an intravenous balanced salt solution was infused during the entire procedure.Sedation was provided under constant monitoring for ventilation, cardiovascular hemodynamics, and oxygenation . Medications used to provide sedation were Propofol, intravenous.
Documentation of the medication used for sedation was under taken on separate charting.
Fluoroscopic evaluation of the lumbar region was under taken. Identification of
the appropriate vertebral levels were identified and skin markings were placed. Area was prepped and draped in a sterile fashion with betadine on 3 separate occasions. Sterile towels were placed. The fluoroscopic image was obtained in an AP view and identification of the vertebral body was verified. A total of 5 vertebral bodies were identified. The image was then rotated to the Left and the L3/4 pedicle was placed into focus until and appropriate view of the " Scottie Dog" image was obtained and the facet joint visualization was maximized. Just lateral to the pedicle was identified correlating to
the "eye of the Scottie dog", groove along which the medial branch nerve travels. 5 cc's of 1 % lidocaine was injected in the subcutaneous tissue using a 25 ga 1 ? inch needle. At the L3/4 on the Left a 22 ga radiofrequency needle was placed with gentle manipulation under fluoroscopic guidance. Verification of needle placement was obtained and copy of which was placed on patients record and saved on the hard drive of the fluoroscopic
machine, Zheim Exposcop. After confirmation of needle placement over the appropriate location, eye of the Scottie dog, a total solution containing 1 cc of 0.5% bupivacaine and 10 mg of depo medrol solution was injected at each level respectively for a total of 30 mg of methylprednisolone, the residual 10 mg in the vial was disposed of appropriately.
Radiofrequency lesions were performed in the Direct burn mode after confirmation of impedance, negative motor response to 3mv and a positive sensory response at appropriate levels prior to lessoning. Recordings of the appropriate impedance, sensory and motor values were placed on the patients permanent record on a separate radiofrequency sheet. Radiofrequency lesions were performed for 90 seconds at a temperature of 80 degrees celsius. The needle was then removed and the procedure was
repeated in the exact same dimensions above at the L3/4 to L5/S1 levels inclusive. A total of 3 levels were performed. Needles were removed and fluoroscopic images were obtained and saved on the machines hard drive and a copy of which was placed on the patients permanent office record. Patient was alert to verbal and tactile stimuli during the entire procedure.