Wiki Stereotactic lesion of the spinal nerve

[heatherj_k@yahoo.com]

I have a question, my provider performed Stereotactic lesion of the spinal nerve: selective left C1-C2 (C2 dorsal root ganglion) and right C1-C2 (C2 dorsal root ganglion) radiofrequency ablation under Flouoroscopy. Coded as 64640 as well as 64999. Which code is appropriate?

 

[SharonCollachi]

Is it pulsed or cooled or thermal (conventional)?

 

[heatherj_k@yahoo.com]

This is his dictation:
RFA - Occipital Nerve Preop Diagnosis: Cervicogenic headache Postop Diagnosis: Cervicogenic headache Procedures: Stereotactic lesion of the spinal nerve: selective left C1-C2 (C2 dorsal root ganglion) and right C1-C2 (C2 dorsal root ganglion) radiofrequency ablation under Flouoroscopy Patient presents with intractable pain with positive injection trial. Fluoroscopy necessary for positioning for stereotactic lesion. Prior to the procedure, we discussed the risks of the radiofrequency such as hematoma, infection, and nerve or spinal nerve injury. The patient was also told that sometimes patients will notice upper extremity weakness immediately following the procedure due to extravasation of local anesthetic solution onto the main nerve root during the procedure. In addition, the patient was informed that 1 to 2 weeks of postoperative discomfort following the procedure is to be expected. A timeout procedure was performed according to protocol after positioning and prepping the patient in the usual sterile fashion. The patient was identified, the correct side and site(s) of the procedure was confirmed, and all necessary equipment was available. The Avanos 100 mm reusable Nitinol*-coated cannula with a 10 mm active tip was adjusted via the sizing collar so that the electrode fit just inside the inner bevel at the end of the bare metal. Prior to beginning the procedure, the internal test mode function of the radiofrequency unit was checked to make sure the machine was functioning properly. The overlying skin was prepped with BetadineUsing fluoroscopy, the target area was visualized in the lateral projection. Local anesthesia to the target area was achieved with 10 ml of 1% lidocaine without epinephrine A radiofrequency cannula was prepared. The radiofrequency cannula was then placed in a parallel fashion to the x-ray beam and directed in a bulls-eye fashion down to the target zone. Once the needle was adequately directed into the space, the Carm was projected in an AP view. The needle was then directed medially to the mid facet line. was injected slowly. There was no evidence of intravascular or intrathecal nor epidural injection. Sensory stimulation at 50 hertz was performed at the target area. Sensory stimulation was achieved @ 0.17 volts referral of paresthesia to the appropriate dermatomal level. Motor dissociation at 2 hertz, 0.3 volts was then elicited demonstrating stimulation at 2 times the voltage of sensory stimulation and insuring a lack of motor movement. The lesion site was injected with a solution of 0.5 ml of 2% lidocaine without epinephrine. A total of 20 mg of Methylprednisolone acetate (Depo-Medrol), 40mg was divided for each injection to help diminish post-procedure neuritis. For the left C1-C2 (C2 dorsal root ganglion) and right C1-C2 (C2 dorsal root ganglion): A thermal lesion was generated for a duration of 120 seconds at a temperature of 50 degrees C.