I am getting denials when billing on 64495-LT-59
Assessment:
1. Lumbosacral spondylosis without myelopathy - 721.3 (Primary)
2. Thoracic or lumbosacral neuritis or radiculitis, unspecified - 724.4
3. Postlaminectomy syndrome, lumbar region - 722.83
4. Lumbago - 724.2
5. Encounter for long-term (current) use of other medications - V58.69
6. Encounter for therapeutic drug monitoring - V58.83
Procedures:
Left Transforaminal Sacral Epidural Steroid Injection & Left Lumbar Facet Steroid Injection:
PRE-OPERATIVE DIAGNOSES: Lumbar pain. Lumbar radiculopathy Lumbar spondylosis without myelopathy, Lumbar post laminectomy syndrome.
POST-OPERATIVE DIAGNOSES: Lumbar pain. Lumbar radiculopathy Lumbar spondylosis without myelopathy, Lumbar post laminectomy syndrome.
PROCEDURE I : Percutaneous needle localization of the sacral foramens under the guidance of flouroscopy .
PROCEDURE II : Left transforaminal sacral epidural steroid injection at the levels of S1, S2, and S3.
PROCEDURE III : Percutaneous needle localization of the left lumbar facets.
PROCEDURE IV : Left lumbar facet steroid injection under fluoroscopy x 4 levels , L5-S1, L4-5, L3-4, L2-3.
ANESTHESIA: General; without endotracheal tubing.
PATIENT PREP & POSITIONING :
After the patient was identified, the chart and consent was reviewed and risks and benefits were explained and understood, the patient agreed to proceed. IV fluids were started with lactated ringers and the patient was taken to the operating room. All standard anesthesia monitors including Blood pressure, pulse oximetry and EKG were applied, and IV anesthesia was started by the anesthesiologist as needed. The surgical field was prepped and draped in the usual sterile fashion. The point of entrance was infiltrated by 2% Lidocaine using a #27 gauge block needle.
LEFT TRANSFORAMINAL SACRAL EPIDURAL STEROID INJECTION:
After the correct level has been identified and prepped in a sterile fashion, a skin wheal with a local anesthetic is placed 5-7 cm lateral to the spinous process. The S3 foramen on the left side was targeted with a 22 guage spinal needle. Posterior and anterior view was obtained to conform the position of the needle aspiration of the needle was applied; there was no CSF or blood coming through the needle. At that point total amount of 0.5 cc / 3mg of Celestone, mixed with 1.0 cc / 1 % P.F. Lidocaine injected around the nerve root. This was done at the levels of S2 and S1on the left side.
LEFT LUMBAR FACET STEROID INJECTION:
The lumbar facet joints on the affected side were identified under the fluoroscopy at the four levels of L2-3, L3-L4, L4-L5, and L5-S1. The most inferior facet at the level of L5-S1 was identified by the fluoroscopy and the skin was infiltrated with #27 gauge block needle with 1.0% plain Lidocaine. A #22 gauge spinal needle inserted at 45 degrees to the skin under the guidance of fluoroscopy. When the tip of the needle confirmed to be inside the facet joint, aspiration technique was applied, there was no blood or cerebral spinal fluid noticed to be coming through the needle. The amount of 0.25 cc of radiopaque dye was injected and the spread of the dye noticed to be satisfactory through the joint space as confirmed by the fluoroscopy. That was followed by injecting a total amount of 1.0 cc / 0.5% Bupivicaine mixed with 0.25 cc / 10 mg Celestone and 0.25 cc / 7.5 mg Toradol. The injectable spread noticed to be adequate through the whole joint space superiorly and inferiorly as confirmed by the fluoroscopy. The whole process was repeated at the other four levels L2-3, L3-L4, L4-L5 and L5-S1.
THIS IS WHAT WE BILL.
99215-25
64483-LT
64484-LT-59
64493-LT-51
64494-LT
64484
64495-LT
64495 -LT-59 < =============== DENIED
J1885
J0702
Q9966
I need to know if the 64495-LT-59 IS OK TO BILL.
Thank you,
Ana
Assessment:
1. Lumbosacral spondylosis without myelopathy - 721.3 (Primary)
2. Thoracic or lumbosacral neuritis or radiculitis, unspecified - 724.4
3. Postlaminectomy syndrome, lumbar region - 722.83
4. Lumbago - 724.2
5. Encounter for long-term (current) use of other medications - V58.69
6. Encounter for therapeutic drug monitoring - V58.83
Procedures:
Left Transforaminal Sacral Epidural Steroid Injection & Left Lumbar Facet Steroid Injection:
PRE-OPERATIVE DIAGNOSES: Lumbar pain. Lumbar radiculopathy Lumbar spondylosis without myelopathy, Lumbar post laminectomy syndrome.
POST-OPERATIVE DIAGNOSES: Lumbar pain. Lumbar radiculopathy Lumbar spondylosis without myelopathy, Lumbar post laminectomy syndrome.
PROCEDURE I : Percutaneous needle localization of the sacral foramens under the guidance of flouroscopy .
PROCEDURE II : Left transforaminal sacral epidural steroid injection at the levels of S1, S2, and S3.
PROCEDURE III : Percutaneous needle localization of the left lumbar facets.
PROCEDURE IV : Left lumbar facet steroid injection under fluoroscopy x 4 levels , L5-S1, L4-5, L3-4, L2-3.
ANESTHESIA: General; without endotracheal tubing.
PATIENT PREP & POSITIONING :
After the patient was identified, the chart and consent was reviewed and risks and benefits were explained and understood, the patient agreed to proceed. IV fluids were started with lactated ringers and the patient was taken to the operating room. All standard anesthesia monitors including Blood pressure, pulse oximetry and EKG were applied, and IV anesthesia was started by the anesthesiologist as needed. The surgical field was prepped and draped in the usual sterile fashion. The point of entrance was infiltrated by 2% Lidocaine using a #27 gauge block needle.
LEFT TRANSFORAMINAL SACRAL EPIDURAL STEROID INJECTION:
After the correct level has been identified and prepped in a sterile fashion, a skin wheal with a local anesthetic is placed 5-7 cm lateral to the spinous process. The S3 foramen on the left side was targeted with a 22 guage spinal needle. Posterior and anterior view was obtained to conform the position of the needle aspiration of the needle was applied; there was no CSF or blood coming through the needle. At that point total amount of 0.5 cc / 3mg of Celestone, mixed with 1.0 cc / 1 % P.F. Lidocaine injected around the nerve root. This was done at the levels of S2 and S1on the left side.
LEFT LUMBAR FACET STEROID INJECTION:
The lumbar facet joints on the affected side were identified under the fluoroscopy at the four levels of L2-3, L3-L4, L4-L5, and L5-S1. The most inferior facet at the level of L5-S1 was identified by the fluoroscopy and the skin was infiltrated with #27 gauge block needle with 1.0% plain Lidocaine. A #22 gauge spinal needle inserted at 45 degrees to the skin under the guidance of fluoroscopy. When the tip of the needle confirmed to be inside the facet joint, aspiration technique was applied, there was no blood or cerebral spinal fluid noticed to be coming through the needle. The amount of 0.25 cc of radiopaque dye was injected and the spread of the dye noticed to be satisfactory through the joint space as confirmed by the fluoroscopy. That was followed by injecting a total amount of 1.0 cc / 0.5% Bupivicaine mixed with 0.25 cc / 10 mg Celestone and 0.25 cc / 7.5 mg Toradol. The injectable spread noticed to be adequate through the whole joint space superiorly and inferiorly as confirmed by the fluoroscopy. The whole process was repeated at the other four levels L2-3, L3-L4, L4-L5 and L5-S1.
THIS IS WHAT WE BILL.
99215-25
64483-LT
64484-LT-59
64493-LT-51
64494-LT
64484
64495-LT
64495 -LT-59 < =============== DENIED
J1885
J0702
Q9966
I need to know if the 64495-LT-59 IS OK TO BILL.
Thank you,
Ana