missyah20
Guru
Hey all - Our providers are performing Popliteal and Saphenous nerve blocks for acute postop pain management for patients having ankle/foot surgery. I am just looking for some confirmation that codes 64445 and 64450 (Saphenous appears to be the distal thigh area) are the correct codes for the note below. The documentation stating the needle is confirmed in the adductor canal is kind of throwing us off here, but in documents I have read it seems appropriate to use the 64450 for the location which is 8-10 cm above the knee and not being performed in the groin area.
Thanks!
Procedure details:
The patient was identified and procedure confirmed with patient and nurse by way of time out. Risks, benefits, and alternatives were discussed, and the patient wished to proceed. The patient was in pre-procedure room PP 3. EKG, NIBP and SaO2 were monitored and stable throughout this procedure. 02 given via nasal cannula. Sedated with 3 mg of Versed. The patient was placed in a left lateral position. The legs were flexed on a small pillow. The right popliteal region was sterilely prepped with chlorhexidine gluconate. The ultrasound was utilized in the short axis to identify the popliteal artery along with the tibial and common peroneal nerves lying in close proximity to it. The ultrasound was then directed more cephalad where I could see the tibial and common peroneal nerves at the bifurcation off of the sciatic nerve. At this junction, which was about 2 cm above the popliteal crease, a 21-gauge 4.5 inch block needle was advanced in the in-plane technique. The needle was visualized next the tibial and common peroneal nerves. A total volume of 30 cc of 0.5% ropivacaine was injected incrementally with good local anesthetic spread noted around the tibial and common peroneal nerves. Following this, the needle was withdrawn. The patient was returned to the supine position. The right inner thigh was sterilely prepped with chlorhexidine gluconate. The ultrasound was utilized in the short axis to identify the femoral artery lying deep to the sartorius muscle at about 8-10 cm above the knee. A 21-gauge 4 inch block needle was advanced under ultrasound guidance in the in-plane technique. The needle was subfascial, next to the femoral artery and confirmed in the adductor canal by way of ultrasound. Negative aspirate for blood. I then injected 20 mL of 0.5% ropivacaine incrementally with careful aspiration every 5 mL. The local anesthetic was noted to be in the adductor canal. The needle was withdrawn. The patient tolerated the procedure well. Procedure time was 1030 to 1039. Images were saved to the medical record.
Thanks!
Procedure details:
The patient was identified and procedure confirmed with patient and nurse by way of time out. Risks, benefits, and alternatives were discussed, and the patient wished to proceed. The patient was in pre-procedure room PP 3. EKG, NIBP and SaO2 were monitored and stable throughout this procedure. 02 given via nasal cannula. Sedated with 3 mg of Versed. The patient was placed in a left lateral position. The legs were flexed on a small pillow. The right popliteal region was sterilely prepped with chlorhexidine gluconate. The ultrasound was utilized in the short axis to identify the popliteal artery along with the tibial and common peroneal nerves lying in close proximity to it. The ultrasound was then directed more cephalad where I could see the tibial and common peroneal nerves at the bifurcation off of the sciatic nerve. At this junction, which was about 2 cm above the popliteal crease, a 21-gauge 4.5 inch block needle was advanced in the in-plane technique. The needle was visualized next the tibial and common peroneal nerves. A total volume of 30 cc of 0.5% ropivacaine was injected incrementally with good local anesthetic spread noted around the tibial and common peroneal nerves. Following this, the needle was withdrawn. The patient was returned to the supine position. The right inner thigh was sterilely prepped with chlorhexidine gluconate. The ultrasound was utilized in the short axis to identify the femoral artery lying deep to the sartorius muscle at about 8-10 cm above the knee. A 21-gauge 4 inch block needle was advanced under ultrasound guidance in the in-plane technique. The needle was subfascial, next to the femoral artery and confirmed in the adductor canal by way of ultrasound. Negative aspirate for blood. I then injected 20 mL of 0.5% ropivacaine incrementally with careful aspiration every 5 mL. The local anesthetic was noted to be in the adductor canal. The needle was withdrawn. The patient tolerated the procedure well. Procedure time was 1030 to 1039. Images were saved to the medical record.