I need help! I am new to Spine coding. My Physician and I have completely different thoughts on these codes.
Can someone please tell me how you would code this procedure?
L2-S1 bilateral lumbar facet capsulotomy/transection of accessory spinal nerve with thermal coagulation
C-arm fluoroscopy was brought into the field to identify the lumbosacral facet joints. We then used a 22-gauge needle to infiltrate 1% lidocaine in the deep dermal tissue bilaterally overlying the facet joints L2-S1 and then advanced an 18-gauge spinal needle to the centroid of the left L2-3 facet joint. This was an insulated needle. We then remove the inner stylette and inserted the laser fiber and proceeded to coagulate to a total of 200 J. We then remove the needle and repeated this on the left at L3-4 L4-5 and L5-S1, then again on the right at L2-3 L3-4 L4-5 and L5-S1.
At this point, we took a 20-gauge needle and took a more lateral to medial trajectory, targeting the L5 transverse process. Once we had the transverse process we walked it medially to the inferior articular process of L4-5, which is the lateral part of the facet joint at L5 and walked it off of Camden's triangle until we lost resistance. We then infiltrated a mixture of the half percent Marcaine with 40 mg/mL of Kenalog into the exiting L4 nerve root. We then repeated this procedure on the left at L5-S1.
Can someone please tell me how you would code this procedure?
L2-S1 bilateral lumbar facet capsulotomy/transection of accessory spinal nerve with thermal coagulation
C-arm fluoroscopy was brought into the field to identify the lumbosacral facet joints. We then used a 22-gauge needle to infiltrate 1% lidocaine in the deep dermal tissue bilaterally overlying the facet joints L2-S1 and then advanced an 18-gauge spinal needle to the centroid of the left L2-3 facet joint. This was an insulated needle. We then remove the inner stylette and inserted the laser fiber and proceeded to coagulate to a total of 200 J. We then remove the needle and repeated this on the left at L3-4 L4-5 and L5-S1, then again on the right at L2-3 L3-4 L4-5 and L5-S1.
At this point, we took a 20-gauge needle and took a more lateral to medial trajectory, targeting the L5 transverse process. Once we had the transverse process we walked it medially to the inferior articular process of L4-5, which is the lateral part of the facet joint at L5 and walked it off of Camden's triangle until we lost resistance. We then infiltrated a mixture of the half percent Marcaine with 40 mg/mL of Kenalog into the exiting L4 nerve root. We then repeated this procedure on the left at L5-S1.