Radiofrequency lesioning & spinal injection


Local Chapter Officer
Ames, IA
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I was wondering if it would be appropriate to bill for injections of bupivacaine and depo-medrol prior to the lesioning or if it is considered and integral part of the procedure. Here is an example of an op note.

After the patient was placed on the fluoroscopy bed, an IV was begun and IV
sedation carried out as per recording in the chart with continuous pulse
oximetry monitoring, EKG monitoring and intermittent blood pressure

The patient was placed in the prone position on the fluoroscopy bed. The
back was prepped with Betadine times three, and draped in sterile fashion.
Local anesthesia was carried out under fluoroscopic guidance at the junction
of the superior, and inferior articular pillars at L3-4, 4-5, 5-S1,
superolateral aspect of the S1 foramen on the right. 18 gauge 10 millimeter
active tip RFK needles passed deep to the skin contacting each of these
areas, and verification of placement with AP, oblique, and lateral views
followed by sensory motor stimulation at each level was carried out. Prior
to lesioning, Bupivacaine 0.25% 0.5 cc plus 10 milligrams of Depo-Medrol was
deposed at each site. Lesioning then ensued to a target temperature of 90
degrees times 75 seconds at each level. The needles were then removed.


Denver Colorado
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This is addressed in the CPT Book in the instructions at the beginning of the Destruction by Neurolytic Agent section: Codes 64600 - 64681 include the injection of other therapeutic agents (eg, corticosteroids)

The steroids & the local anesthetic is often used to try and decrease the neuritis pain following a RF procedure. Unless well informed, most patients won't understand why their pain would be SO much worse after having a procedure to try & take it away!