lcole7465
Expert
One of my providers performed a Bilateral Greater & Lesser Occipital RFA. We coded 64640-50 with 2 units are each side since the Greater & Lesser Occipital Nerves.
The op note reads:
"I identified the superior nuchal line under ultrasound. I identified the bilateral greater occipital nerve medial to the pulsation of the occipital artery at the level of the superior nuchal line. I prepped the area with chlorhexidine in sterile fashion technique. I used lidocaine 2% for skin infiltration. I used 22-gauge, 5-mm Active Tip needle. I advanced the needle until I had had good position of the needle over the area of the occipital nerve. The patient reports similar sensation with sensory stimulation below 0.6 mV. There was no motor activity with motor stimulation at 3 V. Then I infiltrated the area with 2 mL of bupivacaine 0.25%. Radio-frequency lesioning of the nerve at 80 degrees Celsius for 60 seconds was performed at the affected level. The patient tolerated the procedure well and transferred to the recovery room in stable condition.
After obtaining consent, the patient was brought to the procedure room and was placed in the prone position. I identified the superior nuchal line under fluoroscopy. I identified the bilateral lesser occipital nerve lateral and slightly inferior to the pulsation of the occipital artery at the level of the superior nuchal line. I prepped the area with chlorhexidine in sterile fashion technique. I used lidocaine 2% for skin infiltration. I used 22-gauge, 10-mm Active Tip needle. I advanced the needle until I had had good position of the needle over the area of the occipital nerve. The patient reports similar sensation with sensory stimulation below 0.6 mV. There was no motor activity with motor stimulation at 3 V. Then I infiltrated the area with 2 mL of bupivacaine 0.25%. Radio-frequency lesioning of the nerve at 80 degrees Celsius for 90 seconds was performed at the affected level.
Any input would be greatly appreciated.
The op note reads:
"I identified the superior nuchal line under ultrasound. I identified the bilateral greater occipital nerve medial to the pulsation of the occipital artery at the level of the superior nuchal line. I prepped the area with chlorhexidine in sterile fashion technique. I used lidocaine 2% for skin infiltration. I used 22-gauge, 5-mm Active Tip needle. I advanced the needle until I had had good position of the needle over the area of the occipital nerve. The patient reports similar sensation with sensory stimulation below 0.6 mV. There was no motor activity with motor stimulation at 3 V. Then I infiltrated the area with 2 mL of bupivacaine 0.25%. Radio-frequency lesioning of the nerve at 80 degrees Celsius for 60 seconds was performed at the affected level. The patient tolerated the procedure well and transferred to the recovery room in stable condition.
After obtaining consent, the patient was brought to the procedure room and was placed in the prone position. I identified the superior nuchal line under fluoroscopy. I identified the bilateral lesser occipital nerve lateral and slightly inferior to the pulsation of the occipital artery at the level of the superior nuchal line. I prepped the area with chlorhexidine in sterile fashion technique. I used lidocaine 2% for skin infiltration. I used 22-gauge, 10-mm Active Tip needle. I advanced the needle until I had had good position of the needle over the area of the occipital nerve. The patient reports similar sensation with sensory stimulation below 0.6 mV. There was no motor activity with motor stimulation at 3 V. Then I infiltrated the area with 2 mL of bupivacaine 0.25%. Radio-frequency lesioning of the nerve at 80 degrees Celsius for 90 seconds was performed at the affected level.
Any input would be greatly appreciated.