New at this, I had a coder put in 64405, but I believe this should be 64490, anyone please help understand..Third Occipital Nerve Block, Cervical Spine Medial Branch Nerve Block
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Pre-operative diagnosis:
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1. Occipital neuralgia of right side M54.81
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Post-operative diagnosis: same
Procedure: right Cervical Spine C2-3 Medial Branch Nerve/Third occipital nerve block between C2-3 (facet) under fluoroscopic guidance
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Indications: This patient has a diagnosis of neck pain due to Occipital neuralgia/headache, Cervicogenic headache and cervical spine spondylosis. Informed consent obtained after explaining the procedure and potential complications including local discomfort, infection, headache, temporary or permanent weakness and/or numbness of one or both legs, temporary or permanent paraplegia, heart attack and stroke. All questions were answered.
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Procedure in detail:
Patient was taken to the procedure room and placed in prone position. Time out was performed. Patient's right lateral neck/cervical spine area was prepped with Chloraprep and draped in a sterile manner.
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Then, lateral fluoroscopy was used to identify and mark the the center of the C2-3 facet joint on the right side. Additionally, the midpoint of the mid-articular pillars at C2-3 on the right were also marked. Then, under lateral fluoroscopic guidance, a 25 G 3.5 inch spinal needle, was advanced to the targeted points corresponding with the locations of the third occipital nerve.
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Then, after negative aspiration for heme and injection of total 1 ml of Omnipaque contrast, Total 1 mL of lidocaine 1% and 40 mg depomedrol was injected at the target point corresponding to the locations of the third occipital nerve.
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Needle was removed and bandaged placed over site of needle insertion.
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Estimated Blood Loss: None
Specimens: None
Disposition: The patient tolerated the procedure without complaint and was transported to the recovery room in stable condition.
Follow-up: The patient will return as scheduled
