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Percutaneous Lysis of Epidural Adhesions

Nancy Posted Wed 22nd of June, 2011 20:07:39 PM

Please tell me how you would code this procedure. Fluoroscopic evaluation of the lumbar region was undertaken with an AP image. Lumbar vertebral bodies were identified. The appropriate vertebral body was identified and the image was rotated antero-caudad until alignment of the endplates was identified. The image was rotated laterally until the neuroforamen was observed and it's maximum opening was noted. Appropriate skin markings were placed. The area was then prepped and draped in a sterile fashoin. .5 cc's of 1% lidocaine was injected in the subcutaneous tissue using a 25 ga 1 1/2 spinal needle at each corresponding level. At the L4 level on the left a 22 ga spinal needle was placed with gentle manipulation under fluoroscopic guidance until contact with the transverse process was noted. The needle was then redirected caudad and medially until placement in the neuroforamen was noted with an AP and lateral view of the fluoroscopic image was noted. The needle was noted in the upper pole of the formen and did not pass medically to the pedicle of the AP fluoroscopic view. After verification of the needle placement a total solution or radiopaque material, omnipaque 300 mg/ml was injected in a slow contiuous fashion. An epiduralgram was interpreted and identified as follows:After negative aspiration to blood, air of fluids the contast material was injected in a slow and contiuous fashion. Spread of which was noted in the epidural space with a distorted fashion. Spread was noted in the caudad and cephalad direction with irregular spread out of the corresponding nueroforamina. This correlated with the preoperative diagnosis established. After interpretation of the epiduralgram a total solution containing 1 cc of preservative free normal saline and a total of 20 mg of depomedrol solution and 250 units of Vitrase for lysis of adhesion, which was confirmed preop with MRI and diagnostic studies, was included in the injectate. The procedure was repeated at the L5 and S levels in the exact same fashion as previously described. A total of 80 mg of depomedrol and 800 units of Vitrase solution was used among all levels. Lysis of epidural adhesions was performed with the medications and needle.
Thank You for any help you can give me .

SuperCoder Answered Thu 23rd of June, 2011 16:30:18 PM

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