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Lumbar Interlaminar vs Lumbar Transforaminal ESI Injections

To Whom It May Concern,

I need some help with a Pain Management procedure. What key words do I need to look for in a procedure note to differentiate between a Lumbar Interlaminar ESI Injection (CPT 62323) and a Lumbar Transforaminal ESI Injection (CPT 64483) so it can be coded accurately?

Below is the providers procedure note for review:

Procedure: Lumbar Epidural Steroid Injection under fluoroscopy.
Diagnosis: Lumbar Degenerative Disc Disease

The patient was evaluated and the procedure risks, benefits and alternatives were discussed with the patient. Informed consent was then obtained.
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The patient was taken into the procedure room and was placed prone on the table. Skin was prepped with chloraprep and draped in a sterile manner. Sterile technique was observed throughout the procedure. Fluoroscopy was used to identify the targeted L4-5 L5-S1 interspace. Using a 25 gauge needle 5cc of 1% lidocaine was used to achieve adequate local anesthesia.

A 20 gauge epidural needle was advanced into the epidural space under fluoroscopic guidance utilizing the loss or resistance technique[/COLOR][/COLOR]. No parasthesias were noted. After negative aspiration 1 ml of 300 omnipaque was injected. Contrast was confirmed in the epidural space via fluoroscopy. Methylprednisolone [ ] mg mixed with [ ] ml normal saline was slowly injected. The needle was removed intact. The patient remained awake and communicative throughout the procedure with no complaints of pain on injection.

The patient received 50-60% relief from this procedure.

The patient tolerated the procedure well and was transferred to the recovery area without complication and was discharged home after remaining stable during observation.

Appreciate your help.
Thank you.
Lauren

Medical Billing and Coding Forum

Transforaminal Epidural Steroid injection

How would you code the following? Any input would be greatful!

Post-op diagnosis: Lumbar Radiculitis
Procedure Performed: Flouroscopic Guidance, Bilateral Transforaminal Epidural Steroid Injection
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Description of Procedure;
Informed consent was obtained. Standard monitors were applied. The patient was reexamined, turned into the prone position and sterilely prepped and draped. Skin wheals were made with a total of 5 cc 1% lidocaine. Using biplanar fluoroscopic guidance a 22 guage 5 inch quincke block needle was advanced at the 6 O’clock position underneath the pedicles at L4 Bilateral, L5 Bilateral and S1 Bilateral. Once the needle tip was felt to be in the appropriate position, the xray beam was turned to the lateral projection to demonstrate the needle tip over the neuroforamen. After negative aspiration, 0.2 cc’s of Isovue-300 contrast media was injected at each level to demonstrate proper epidural/selective nerve root spread without any indication of intravascular or subarachnoid uptake. Subsequently, and again after negative aspiration at each level, 0.5cc of 6 mg Betamethasone and 0.3 cc’s of 1% preservative free Lidocaine was injected at each level. No paresthesia was noted with final position and contrast provacation was negative. The patient tolerated the procedure well. A detailed report was given to the receiving nurse.
*
Additional Comments:
Specimens Removed: None
Complications: None
Estimated Blood Loss: None
Findings: The patient was reevaluated immediately post-procedure and then again after 10 minutes.
Fluoro:30 secs
*
PLAN:
The patient is to follow up in the office in 2 weeks.

Medical Billing and Coding Forum