minte1
New
I need some clarification for coding a SI RFA, I have been given 3 different answers for coding; 64640, or 64640 with 64635, or 64640 with 64999? Please see note below:
Any help would be greatly appreciated, Thank You!
Procedures
RFA (Strip Lesioning) of SI Joint:
Consent Patient's history and physical exam were reviewed. The risks, benefits and alternatives to the procedure were discussed and all the questions were answered to the patients satisfaction. The patient agreed to proceed and written informed consent was obtained. .
IV Yes.
Anesthesia Monitored Anesthesia Care.
Location(s) Right .
Fluoroscopy Yes.
Prep Chloroprep.
Needle 17 G diamond tip probe.
Meds 6 ml 40 mg Depo-Medrol 0.25% Marcaine.
Procedure After obtaining informed consent; the patient was brought to the procedure room, placed in the prone position with a pillow placed beneath the abdomen to reduce the lumbar lordotic curvature. A dispersal grounding pad was applied to the posterior thigh and the lower lumbar region and buttocks was sterilely prepared and surgically draped. An antero-posterior (AP) projection with a vertical position of the C-arm, centered on the inferior border of the ipsilateral sacrum was obtained. The target point at the ipsilateral, lateral, inferior border of the sacrum, just lateral to the S4 foramen was identified and a local anesthetic skin wheal was raised 1 cm below this target point using a #25-gauge 3-1/2 inch, curved, Quinke tip, spinal needle and 1% buffered lidocaine. The needle was then advanced to contact the sacral target point making sure that the sacrum was contacted at an appropriate depth and that the needle had not entered either the S4 or any other sacral foramen, or ventured inferior to the sacral margin and into the pelvic cavity. Once the periosteum was contacted, the needle was then advanced in a cephalad and slightly lateral direction, staying lateral to the sacral foramen, in contact with the sacrum, and medial to the joint, and advanced into the ligamentous tissue between the sacrum and ilium. Once advanced along this line to a point where no further cephalad advancement could occur, the stylette was removed and a syringe containing 4 cc of 4% lidocaine and 1 cc non-particulate steroid was injected as the needle was withdrawn, to anesthetize the lesion track. Additional injections of this local anesthetic solution were made along the intended lesion track as necessary to optimize patient comfort. Attention was then redirected to the initial target point at the inferolateral border of the sacrum. The electrodes were then inserted through the previously created skin wheal until contacting the inferolateral border of the sacrum and verifying that the tip did not enter a sacral foramen or proceed inferior to the inferior border of the sacrum. The electrodes were then advanced, maintaining continuous contact with the sacrum, on a cephalad and slightly lateral line, staying lateral to the sacral foramen, medial to the sacroiliac joint, and ventral to the ilium, until contact with the sacral ala prevented further advancement. Appropriate positioning was confirmed by changing the caudal/cephalad tilt of the C-arm to parallel the superior endplate of S1 and verifying, once again, that the electrodes advanced to the ipsilateral sacral ala and independent, active contacts were positioned adjacent to the S1, S2, S3, and S4 lateral branch innervation pathways. A lateral view was then obtained, confirming that the electrodes remained in contact with the sacral periosteum, followed the curvature of the sacrum up to the sacral ala, and the active contacts were in an appropriate position to lesion the lateral branches of S1, S2, S3, and S4 Lesioning was then carried out at 85 degrees centigrade for 60 seconds at each level. The patient tolerated the procedure well without complication and each electrode was removed without difficulty and verified to be intact..
Disposition Patient tolerated the procedure well and there were no complications. Vital signs remained stable throughout the procedure. The patient was taken to the recovery area where written discharge instructions for the procedure were given. .
Any help would be greatly appreciated, Thank You!
Procedures
RFA (Strip Lesioning) of SI Joint:
Consent Patient's history and physical exam were reviewed. The risks, benefits and alternatives to the procedure were discussed and all the questions were answered to the patients satisfaction. The patient agreed to proceed and written informed consent was obtained. .
IV Yes.
Anesthesia Monitored Anesthesia Care.
Location(s) Right .
Fluoroscopy Yes.
Prep Chloroprep.
Needle 17 G diamond tip probe.
Meds 6 ml 40 mg Depo-Medrol 0.25% Marcaine.
Procedure After obtaining informed consent; the patient was brought to the procedure room, placed in the prone position with a pillow placed beneath the abdomen to reduce the lumbar lordotic curvature. A dispersal grounding pad was applied to the posterior thigh and the lower lumbar region and buttocks was sterilely prepared and surgically draped. An antero-posterior (AP) projection with a vertical position of the C-arm, centered on the inferior border of the ipsilateral sacrum was obtained. The target point at the ipsilateral, lateral, inferior border of the sacrum, just lateral to the S4 foramen was identified and a local anesthetic skin wheal was raised 1 cm below this target point using a #25-gauge 3-1/2 inch, curved, Quinke tip, spinal needle and 1% buffered lidocaine. The needle was then advanced to contact the sacral target point making sure that the sacrum was contacted at an appropriate depth and that the needle had not entered either the S4 or any other sacral foramen, or ventured inferior to the sacral margin and into the pelvic cavity. Once the periosteum was contacted, the needle was then advanced in a cephalad and slightly lateral direction, staying lateral to the sacral foramen, in contact with the sacrum, and medial to the joint, and advanced into the ligamentous tissue between the sacrum and ilium. Once advanced along this line to a point where no further cephalad advancement could occur, the stylette was removed and a syringe containing 4 cc of 4% lidocaine and 1 cc non-particulate steroid was injected as the needle was withdrawn, to anesthetize the lesion track. Additional injections of this local anesthetic solution were made along the intended lesion track as necessary to optimize patient comfort. Attention was then redirected to the initial target point at the inferolateral border of the sacrum. The electrodes were then inserted through the previously created skin wheal until contacting the inferolateral border of the sacrum and verifying that the tip did not enter a sacral foramen or proceed inferior to the inferior border of the sacrum. The electrodes were then advanced, maintaining continuous contact with the sacrum, on a cephalad and slightly lateral line, staying lateral to the sacral foramen, medial to the sacroiliac joint, and ventral to the ilium, until contact with the sacral ala prevented further advancement. Appropriate positioning was confirmed by changing the caudal/cephalad tilt of the C-arm to parallel the superior endplate of S1 and verifying, once again, that the electrodes advanced to the ipsilateral sacral ala and independent, active contacts were positioned adjacent to the S1, S2, S3, and S4 lateral branch innervation pathways. A lateral view was then obtained, confirming that the electrodes remained in contact with the sacral periosteum, followed the curvature of the sacrum up to the sacral ala, and the active contacts were in an appropriate position to lesion the lateral branches of S1, S2, S3, and S4 Lesioning was then carried out at 85 degrees centigrade for 60 seconds at each level. The patient tolerated the procedure well without complication and each electrode was removed without difficulty and verified to be intact..
Disposition Patient tolerated the procedure well and there were no complications. Vital signs remained stable throughout the procedure. The patient was taken to the recovery area where written discharge instructions for the procedure were given. .