My physician performed a 1. Left L4-L5 and L5-S1 interfacet joint injection utilizing fluoroscopy and 2. Left SI joint injection utilizing fluoroscopy for guidance. But, Encoder Pro states that 27096 bundles with 64493 and no modifier is allowed. Does anyone have any suggestions as to how this should be coded, then?
Thanks, in advance, for all of your help! (Please see the procedure note below.)
DESCRIPTION OF PROCEDURE:
The patient was identified. A written and verbal informed consent was obtained. Vital signs were evaluated and monitored throughout the procedure. The patient was presented to the fluoroscopy suite and positioned prone. The skin overlying the lumbar and sacral region was thoroughly cleansed with Betadine solution and draped in a sterile fashion. IV access was obtained in the upper limb. Upon initiation of the procedure, due the patientâ€™s blood pressure and desire to minimize discomfort, the patient received 6.25 mcg of fentanyl IV push. Utilizing fluoroscopy for visualization, we viewed the left L4-L5 and L5-S1 facet joints with AP and oblique views. A 27-gauge 1.5-inch needle was utilized to administer buffered 1% lidocaine to produce a subcutaneous wheal overlying these two facet joints on the left. Once completed, 22-gauge 3.5-inch spinal needles were utilized as guided by fluoroscopy to penetrate the skin, subcutaneous, and intramuscular tissue towards these joints. AP, lateral, and oblique views were utilized to guide the placement of the needles. Once it was determined that we were within the joints, the patient received 0.25 mL of contrast, Omnipaque 180, following negative aspirations for blood and/or CSF. Once contrast confirmed the proper location and the absence of intravascular injection, the patient received 0.5 mL of injectate at each of the facet joints following negative aspirations for blood and/or CSF. Injectate included a mixture of 1.5 mL of 0.75% Marcaine and 1.5 mL of betamethasone (6 mg/mL). The stylets were replaced within the needles, and the needles were withdrawn. The area then overlying the lumbar and sacral joint on the left was exposed with fluoroscopic imaging. Palpation over the painful area confirmed as site of pain as visualized with fluoroscopy. The targeted area of skin overlying the left sacroiliac joint was identified. A 27-gauge 1.25-inch needle was utilized to administer 1% buffered lidocaine to produce a subcutaneous wheal overlying the one-third caudad portion of the left SI joint. A 22-gauge 3.5-inch needle was then guided by fluoroscopy towards the left SI joint. Penetration within the space was difficult, likely based on sclerosis and calcification of this actual anatomic joint space in this patient of age. Once it was felt that we were in a close location, the patient received 0.25 mL of contrast following negative aspiration to confirm the absence of intravascular injection. Contrast was Omnipaque 180. At this point, the patient received 1.5 mL of injectate. Injectate included a mixture of 2 mL of 0.75% Marcaine and 1 mL (6 mg/mL) betamethasone. The stylet was replaced in the needle, and the needle was withdrawn. Identical format was carried out to a more medial and cephalad direction for the left SI joint. Again, contrast was used to confirm the absence of intravascular injection, and the patient received the remainder of the 3 mL of injectate following negative aspirations for blood. The area was thoroughly cleansed. Adhesive bandages were placed, and the patient was returned to the recovery area. There was no evidence of intravascular or intraneural injection. There were no complications with the procedure. She was stable and ambulatory upon discharge. Her preprocedure VAS was a 7. Her postprocedure VAS was a 6. We will contact her within 24 hours to further evaluate her response to todayâ€™s procedure.
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