ortho1991
Guru
Hi all looking for information regarding lateral branch radiofrequency ablation with fluro should this be coded 64640 or 64635+64636
your thoughts and guidance will be appreciated. Thank you
Left L5, S1 and S2 lateral branch radiofrequency ablation with fluro
PROCEDURE: After thorough discussion with the patient regarding the risks and benefits of the
procedure, all of the patient’s questions were answered and an informed written consent was obtained.
(Risks: bleeding, infection, nerve damage, paralysis, pneumothorax, failed treatment and possible
worsening of symptoms; Benefits: diagnostic information and therapeutic effects.)
The patient was brought to the operating room and placed in the prone position. A small pillow was
placed underneath the patient's abdomen in order to flatten the lumbar lordotic curve.
The skin above the region to be injected was cleaned with a surgical prep solution three times in the
usual sterile fashion. A sterile field was then created by draping around the prepped site. The skin and
subcutaneous tissue over the target area was then anesthetized using 0.5% Lidocaine with a 25-gauge 1.5
inch needle. With intermittent fluoroscopy to minimize the dose of radiation, a 22-gauge spinal radio
frequency needle was advanced to the junction of the superior aspect of the targeted transverse process
and the lateral aspect of the superior articulating process at the same level. The needle was then walked
over the transverse process and advanced 2 to 3 mm to lie along the path of the corresponding lateral
branch nerve. AP and lateral images were obtained to verify proper needle position. Sensory and motor
stimulation were then performed, which elicited deep local back discomfort but no evidence of motor
stimulation in the gluteal muscles or extremities. These values are recorded in the nursing notes. After
negative aspiration for air, blood or CSF, a solution consisting of 1 mL of 2% Lidocaine was injected and
a period of one minute was allowed to elapse in order for the nerve to become anesthetized. Nerve
branch denervation was performed for a period 90 seconds at 80 degrees Celsius with a 15 second ramp
up time. Again after negative aspiration for air, blood or CSF, a 1 mL volume of a solution consisting of
1:1 mixture of triamcinolone 40 mg/mL and 0.25% bupivacaine was injected through the needle. The
needles were then removed and the needle tract was flushed with lidocaine. This procedure was
performed at each of the above mentioned sites.
your thoughts and guidance will be appreciated. Thank you
Left L5, S1 and S2 lateral branch radiofrequency ablation with fluro
PROCEDURE: After thorough discussion with the patient regarding the risks and benefits of the
procedure, all of the patient’s questions were answered and an informed written consent was obtained.
(Risks: bleeding, infection, nerve damage, paralysis, pneumothorax, failed treatment and possible
worsening of symptoms; Benefits: diagnostic information and therapeutic effects.)
The patient was brought to the operating room and placed in the prone position. A small pillow was
placed underneath the patient's abdomen in order to flatten the lumbar lordotic curve.
The skin above the region to be injected was cleaned with a surgical prep solution three times in the
usual sterile fashion. A sterile field was then created by draping around the prepped site. The skin and
subcutaneous tissue over the target area was then anesthetized using 0.5% Lidocaine with a 25-gauge 1.5
inch needle. With intermittent fluoroscopy to minimize the dose of radiation, a 22-gauge spinal radio
frequency needle was advanced to the junction of the superior aspect of the targeted transverse process
and the lateral aspect of the superior articulating process at the same level. The needle was then walked
over the transverse process and advanced 2 to 3 mm to lie along the path of the corresponding lateral
branch nerve. AP and lateral images were obtained to verify proper needle position. Sensory and motor
stimulation were then performed, which elicited deep local back discomfort but no evidence of motor
stimulation in the gluteal muscles or extremities. These values are recorded in the nursing notes. After
negative aspiration for air, blood or CSF, a solution consisting of 1 mL of 2% Lidocaine was injected and
a period of one minute was allowed to elapse in order for the nerve to become anesthetized. Nerve
branch denervation was performed for a period 90 seconds at 80 degrees Celsius with a 15 second ramp
up time. Again after negative aspiration for air, blood or CSF, a 1 mL volume of a solution consisting of
1:1 mixture of triamcinolone 40 mg/mL and 0.25% bupivacaine was injected through the needle. The
needles were then removed and the needle tract was flushed with lidocaine. This procedure was
performed at each of the above mentioned sites.