lcole7465
Expert
This one has me a little stumped.. The doctor wants coded: 64635;64640 x3
The op reports reads as follows:
Procedure:
Right RFA of sacroiliac joint, specifically the dorsal ramus of L5 and lateral branches of S1,S2 and S3.
Patient was placed in the prone position. I identified the sacral ala and the superior articular process of S1. I prepped the area with chlorhexidine in the usual sterile fashion technique. I used lidocaine 2% for skin infiltration. I used a 22-gauge, 10-mm Active Tip needle. I advanced the needle until I had good position of the needle into the junction between the sacral ala and the superior articular process of S1. Then we identified the most median and superior part of the SI joint. I advanced the needle towards the most lower and inferior portion of the SI joint on the right side until I had good position of the needle into the above level in the AP and lateral views. The following technique was used to confirm placement at the median branch nerves.
Sensory stimulation was applied to each level at 50Hz; paresthesias were noted below 0.6 microvolts. Motor stimulation was applied at 2 Hz with 1 millisecond duration; corresponding paraspinal muscle twitching without extremity movement was noted. Following this, the need trocar was removed and a syringe containing 0.25% bupivicaine was attached. At each level, after syringe aspiration with no blood return, 1 mL of 0.25% bupivicaine was injected to anesthetize the median branch nerve and surrounding tissue. After completion of each nerve block, a lesion was created at that level with a temperature of 80 degrees Celsius for 90 seconds.![Confused :confused: :confused:](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
The op reports reads as follows:
Procedure:
Right RFA of sacroiliac joint, specifically the dorsal ramus of L5 and lateral branches of S1,S2 and S3.
Patient was placed in the prone position. I identified the sacral ala and the superior articular process of S1. I prepped the area with chlorhexidine in the usual sterile fashion technique. I used lidocaine 2% for skin infiltration. I used a 22-gauge, 10-mm Active Tip needle. I advanced the needle until I had good position of the needle into the junction between the sacral ala and the superior articular process of S1. Then we identified the most median and superior part of the SI joint. I advanced the needle towards the most lower and inferior portion of the SI joint on the right side until I had good position of the needle into the above level in the AP and lateral views. The following technique was used to confirm placement at the median branch nerves.
Sensory stimulation was applied to each level at 50Hz; paresthesias were noted below 0.6 microvolts. Motor stimulation was applied at 2 Hz with 1 millisecond duration; corresponding paraspinal muscle twitching without extremity movement was noted. Following this, the need trocar was removed and a syringe containing 0.25% bupivicaine was attached. At each level, after syringe aspiration with no blood return, 1 mL of 0.25% bupivicaine was injected to anesthetize the median branch nerve and surrounding tissue. After completion of each nerve block, a lesion was created at that level with a temperature of 80 degrees Celsius for 90 seconds.