I am hoping someone can help me. This is the documentation I was given. I have a lot of questions.
The Left L4 foramen was identified in AP, lateral and oblique projections. In the oblique view, the entry point just inferior to the pedicle was identified and a mark was made on the skin. The skin and subcutaneous tissues were anesthetized with 1% lidocaine via 27-gauge needle. A 25-gauge 4.5inch spinal needle was then advanced via fluoroscopy in the oblique, lateral and AP projections, into the superior aspect of the L4 foramen on the left. Positioning was confirmed with 1ml of ISOVUE 200. There was no blood, cerebrospinal fluid, or paresthesias. At that point, a mixture of 6mg Decadron with 2ml of PFNS was slowly injected after negative aspiration. Needle was cleared with 0.5 cc of PF normal saline and removed atraumatically.
Attention was then directed to the L5-S1 interspace. The skin and subcutaneous tissues were anesthetized with 1% lidocaine via 27-gauge needle. A 20-gauge, 6 inch, Weiss needle was then advanced via fluoroscopy into the epidural space in a left paramedian approach at L5-S1. There was no blood, cerebrospinal fluid, or paresthesias. Needle placement confirmed wirh 1ml of ISOVUE 200. Then, 40mg Depomedrol mixed with 3ml PFNS was slowly injected after negative aspiration. Needle cleared with 0.5cc 1% lidocaine and removed atraumatically.
1. How do I know it's a translaminar or transforaminal procedure? Am I to know this by the location descriptors?
2. What is Isovue200 and can that be coded?
3. What are PFNS's? When I research I come up with a procedure and this context makes me feel it's a medication.
As you can see I need a lot of guidance. Could you please help me code this? Thanks in advance!!!
The Left L4 foramen was identified in AP, lateral and oblique projections. In the oblique view, the entry point just inferior to the pedicle was identified and a mark was made on the skin. The skin and subcutaneous tissues were anesthetized with 1% lidocaine via 27-gauge needle. A 25-gauge 4.5inch spinal needle was then advanced via fluoroscopy in the oblique, lateral and AP projections, into the superior aspect of the L4 foramen on the left. Positioning was confirmed with 1ml of ISOVUE 200. There was no blood, cerebrospinal fluid, or paresthesias. At that point, a mixture of 6mg Decadron with 2ml of PFNS was slowly injected after negative aspiration. Needle was cleared with 0.5 cc of PF normal saline and removed atraumatically.
Attention was then directed to the L5-S1 interspace. The skin and subcutaneous tissues were anesthetized with 1% lidocaine via 27-gauge needle. A 20-gauge, 6 inch, Weiss needle was then advanced via fluoroscopy into the epidural space in a left paramedian approach at L5-S1. There was no blood, cerebrospinal fluid, or paresthesias. Needle placement confirmed wirh 1ml of ISOVUE 200. Then, 40mg Depomedrol mixed with 3ml PFNS was slowly injected after negative aspiration. Needle cleared with 0.5cc 1% lidocaine and removed atraumatically.
1. How do I know it's a translaminar or transforaminal procedure? Am I to know this by the location descriptors?
2. What is Isovue200 and can that be coded?
3. What are PFNS's? When I research I come up with a procedure and this context makes me feel it's a medication.
As you can see I need a lot of guidance. Could you please help me code this? Thanks in advance!!!