COMPauditor
Contributor
- Messages
- 20
- Best answers
- 0
Because their are no facet joints in the sacral region, I am quite hesitant to use CPT codes 64633-64636. I am also not sure about using 64640, since this is for other peripheral nerve or branch. I have done some research and some say use 64640 and other's 64999. Not a fan of unlisted codes, but my thinking is geared more towards 64999. Below is the procedure and technique, any guidance is extremely appreciated!!
Procedure: Sacral Rhizotomy at L5, S1, S2 and S3 lateral branches on the right side under fluoroscopic guidance.
Technique: The sacral region was prepped and draped in the usual sterile fashion using Betadine as the prep solution, under fluoroscopic guidance the sacroiliac joints as noted above were identified and marked. A contra-lateral oblique view was obtained. A line was drawn on the skin parallel to the joint approximately 1/3 to 1/2 the distance between the joint and a line connecting the lateral aspects of the posterior S1-S3 foramen. Local infiltrative analgesia was achieved by injection of 10 cc's of 1% Lidocaine using a 1 1/2 inch 25 gauge needle at the marked location(s) as noted above with infiltration through subcutaneous tissues down to the sacrum along a parallel line to the SI joint. A curve 100mm radio-frequency needle with a 10mm active tip was advanced just lateral to the joint starting at the sacral ala. Sensory stimulation was performed at each level noted above at 50Hz. A radio-frequency lesion was performed at 80 degrees Celsius for a 90 second burn at the primary dorsal ramus at L5, lateral branch division(s) at each sacral level noted above. The needle was then turned 180 degrees toward the sacral foramen and a second radiofrequency lesion was then carried out in a manner analogous to the above.
Procedure: Sacral Rhizotomy at L5, S1, S2 and S3 lateral branches on the right side under fluoroscopic guidance.
Technique: The sacral region was prepped and draped in the usual sterile fashion using Betadine as the prep solution, under fluoroscopic guidance the sacroiliac joints as noted above were identified and marked. A contra-lateral oblique view was obtained. A line was drawn on the skin parallel to the joint approximately 1/3 to 1/2 the distance between the joint and a line connecting the lateral aspects of the posterior S1-S3 foramen. Local infiltrative analgesia was achieved by injection of 10 cc's of 1% Lidocaine using a 1 1/2 inch 25 gauge needle at the marked location(s) as noted above with infiltration through subcutaneous tissues down to the sacrum along a parallel line to the SI joint. A curve 100mm radio-frequency needle with a 10mm active tip was advanced just lateral to the joint starting at the sacral ala. Sensory stimulation was performed at each level noted above at 50Hz. A radio-frequency lesion was performed at 80 degrees Celsius for a 90 second burn at the primary dorsal ramus at L5, lateral branch division(s) at each sacral level noted above. The needle was then turned 180 degrees toward the sacral foramen and a second radiofrequency lesion was then carried out in a manner analogous to the above.