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The op note reads:
"I identified the superior nuchal line under ultrasound. I identified the bilateral greater occipital nerve medial to the pulsation of the occipital artery at the level of the superior nuchal line. I prepped the area with chlorhexidine in sterile fashion technique. I used lidocaine 2% for skin infiltration. I used 22-gauge, 5-mm Active Tip needle. I advanced the needle until I had had good position of the needle over the area of the occipital nerve. The patient reports similar sensation with sensory stimulation below 0.6 mV. There was no motor activity with motor stimulation at 3 V. Then I infiltrated the area with 2 mL of bupivacaine 0.25%. Radio-frequency lesioning of the nerve at 80 degrees Celsius for 60 seconds was performed at the affected level. The patient tolerated the procedure well and transferred to the recovery room in stable condition.
After obtaining consent, the patient was brought to the procedure room and was placed in the prone position. I identified the superior nuchal line under fluoroscopy. I identified the bilateral lesser occipital nerve lateral and slightly inferior to the pulsation of the occipital artery at the level of the superior nuchal line. I prepped the area with chlorhexidine in sterile fashion technique. I used lidocaine 2% for skin infiltration. I used 22-gauge, 10-mm Active Tip needle. I advanced the needle until I had had good position of the needle over the area of the occipital nerve. The patient reports similar sensation with sensory stimulation below 0.6 mV. There was no motor activity with motor stimulation at 3 V. Then I infiltrated the area with 2 mL of bupivacaine 0.25%. Radio-frequency lesioning of the nerve at 80 degrees Celsius for 90 seconds was performed at the affected level.
Any input would be greatly appreciated.
I am struggling with an orthopedic office and an unlisted code of 29999, which I am using to code either an arthroscopic corocoplasty OR a micfrofracture of greater tuberosity. The surgeons office is not booking with this procedure and when we ask they say they are not going to do it, but end up doing it. The problem is with my Medicare patients, Medicare leaves it to their responsibilities, and I am not having them sign an ABN because the surgeon is stating he will not be doing that procedure. The surgeons office is not disclosing if they bill or not the 29999 (kind of shady). I need help with this code. Can the ortho clinic legally not bill this code even though it is on the op report? any advice would be helpful on this matter. I need something concrete to go to the surgeon ortho clinic about this, but I cannot find anything. Thank you
Dx: Partial Rotator Cuff Tear, Left Shoulder
Adhesive Capsulitis
Procedures Performed
Arthroscopy, Capsular Release
Decompression
Drilling Greater Tuberosity
These are the codes I have selected for the first 2 procedures
CPT 29825 for the capsular release
CPT 29826 for the decompression
I am unsure of the code to use for the Drilling of the Greater Tuberosity
I will quote from the portion of the operative note regarding this…."Four drill holes were made in the greater tuberosity. Four were just lateral to the insertion of the greater tuberosity and one was at the insertion where there was a small partial thickness tear. The drilling was done with the 0.0625 K-wire. Shoulder was drained. Portals were closed ……..
Not sure if this procedure should be included in the 29826
Thanks for any and all help,
CW