KristinM522
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Can someone please tell me how many levels they would code on this scenario? I coded 64635 RT 64636 RTx3 But Humana has sent a request to recoup money saying we should've only billed for 2 additional levels. We are also currently battling with them on a similar scenario where we did 3 levels and they are saying we should've only billed for 2 (L3,L4,L5 fully denervating L4-5, L5-S1, partially L3-4). I feel like this is the beginning of a long list of take backs, if I am coding it wrong I need to nip it ASAP! Thanks in advance for any responses!
TITLE OF PROCEDURE: Radiofrequency Denervation of the Medial Branch (and primary dorsal ramus) Nerves under fluoroscopic guidance
NERVES TREATED: Medial branches *L2, L3, L4, L5
Providing full denervation of the L3-4, L45 and L5S1 facet joints and partial denervation of the L2-3 facet joint
The appropriate level of the lumbar spine was identified under fluoroscopy. 3 ml of lidocaine 1% was injected in the subcutaneous tissue to provide superficial anesthesia per level. Following this, a 100 millimeter, 18 gauge, curved radiofrequency needle with a 10 mm active tip was guided to the target point at the medial border of the transverse process or sacral ala and the junction with the superior articular process under AP, oblique and lateral fluoroscopic projections. Motor stimulation at 2 Hz was performed with no evidence of distal muscle contraction at each level, but excellent multifidus contraction at <2 volts. Prior to lesioning 1 mL of 2% lidocaine at each level. A final lateral fluoroscopic image was obtained to confirm that the needles remained in the same position before lesioning. The patient then received one 90 second lesioning cycle at 80 degrees centigrade at each level. A second RF cycle was performed with slight rotation of the probes after positioning was confirmed with fluoroscopy again. The probe was then allowed to cool prior to withdrawing. 2ml of 2% lidocaine was then injected as the needle was withdrawn to cool the needle and provide deep and superficial anesthesia. The surgical site preparation was washed off of the patient. Band-Aids were applied if needed. The patient was brought to the recovery area. The patient did very well and the procedure results were discussed. Standard discharge instructions were given to the patient. The patient knows how to contact the clinic should they have any questions or problems.
TITLE OF PROCEDURE: Radiofrequency Denervation of the Medial Branch (and primary dorsal ramus) Nerves under fluoroscopic guidance
NERVES TREATED: Medial branches *L2, L3, L4, L5
Providing full denervation of the L3-4, L45 and L5S1 facet joints and partial denervation of the L2-3 facet joint
The appropriate level of the lumbar spine was identified under fluoroscopy. 3 ml of lidocaine 1% was injected in the subcutaneous tissue to provide superficial anesthesia per level. Following this, a 100 millimeter, 18 gauge, curved radiofrequency needle with a 10 mm active tip was guided to the target point at the medial border of the transverse process or sacral ala and the junction with the superior articular process under AP, oblique and lateral fluoroscopic projections. Motor stimulation at 2 Hz was performed with no evidence of distal muscle contraction at each level, but excellent multifidus contraction at <2 volts. Prior to lesioning 1 mL of 2% lidocaine at each level. A final lateral fluoroscopic image was obtained to confirm that the needles remained in the same position before lesioning. The patient then received one 90 second lesioning cycle at 80 degrees centigrade at each level. A second RF cycle was performed with slight rotation of the probes after positioning was confirmed with fluoroscopy again. The probe was then allowed to cool prior to withdrawing. 2ml of 2% lidocaine was then injected as the needle was withdrawn to cool the needle and provide deep and superficial anesthesia. The surgical site preparation was washed off of the patient. Band-Aids were applied if needed. The patient was brought to the recovery area. The patient did very well and the procedure results were discussed. Standard discharge instructions were given to the patient. The patient knows how to contact the clinic should they have any questions or problems.