SPINAL PROCEDURES
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1# PREOPERATIVE DIAGNOSIS: Cervical radiculopathy.
POSTOPERATIVE DIAGNOSIS: Cervical radiculopathy.
PROCEDURE PERFORMED: Right C8-T1 transforaminal epidural steroid injection
DESCRIPTION OF PROCEDURE: A PAR conference was held with the patient. She agreed to the procedure and placed in the prone position. Back prepped three times with Betadine paint. Her pain is right C8-T1 distribution. She has severe stenosis right C8-T1 . After sterile prep and drape, a 1% lidocaine infiltrated and #22-gauge 5-inch needle advanced to the right C8-T1 foramen. Transforaminal spread was seen with 1 cc of Omnipaque-300 and washed out under live fluoroscopy with 12 mg of Celestone and 1 cc of 1% lidocaine. The patient tolerated the procedure well and discharged in good condition with instructions for followup.
CODES :
Cpt: 64479 , Dx-723.4 , Px-03.92.
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2#
PREOPERATIVE DIAGNOSIS: Lumbar radiculopathy.
2#
PREOPERATIVE DIAGNOSIS: Lumbar radiculopathy.
POSTOPERATIVE DIAGNOSIS: Lumbar radiculopathy.
PROCEDURE PERFORMED: Right L5-S1 transforaminal epidural steroid injection
DESCRIPTION OF PROCEDURE: A PAR conference was held with the patient. She agreed to the procedure and placed in the prone position. Back prepped three times with Betadine paint. Her pain is right L5-S1 distribution. She has severe stenosis right L5-S1. After sterile prep and drape, a 1% lidocaine infiltrated and #22-gauge 5-inch needle advanced to the right L5-S1 foramen. Transforaminal spread was seen with 1 cc of Omnipaque-300 and washed out under live fluoroscopy with 12 mg of Celestone and 1 cc of 1% lidocaine. The patient tolerated the procedure well and discharged in good condition with instructions for followup.
CODES :
Cpt: 64483 , Dx-724.4 , Px-03.92.
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3#
3#
PREOPERATIVE DIAGNOSIS: Spinal stenosis.
POSTOPERATIVE DIAGNOSIS: Spinal stenosis.
PROCEDURE PERFORMED: An C3-C4 interlaminar epidural steroid injection with fluoroscopic guidance.
DESCRIPTION OF THE PROCEDURE: The patient was positioned prone on the radiolucent table. The back was prepped and draped in the usual sterile fashion. The C-arm was positioned to give an AP image of the L5-S1 interspace. The skin and subcutaneous tissue over the interspace was infiltrated with 5 cc of 1% lidocaine plain. A 20 gauge Tuohy needle was then inserted and directed towards the L5-S1 interspace. Then using fluoroscopic guidance and loss of resistance technique, the needle was inserted into the epidural space, negative aspirate for CSF or blood, 80 mg of Depo-Medrol and 2 cc of sterile saline, both preservative–free, were injected into the epidural space without complications. The patient tolerated the procedure well.
CODES :
Cpt: 62310 & 77003 , Dx-723.0 , Px-03.92.
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4#
PREOPERATIVE DIAGNOSIS: Spinal stenosis.
4#
PREOPERATIVE DIAGNOSIS: Spinal stenosis.
POSTOPERATIVE DIAGNOSIS: Spinal stenosis.
PROCEDURE PERFORMED: An L5-S1 interlaminar epidural steroid injection with fluoroscopic guidance.
DESCRIPTION OF THE PROCEDURE: The patient was positioned prone on the radiolucent table. The back was prepped and draped in the usual sterile fashion. The C-arm was positioned to give an AP image of the L5-S1 interspace. The skin and subcutaneous tissue over the interspace was infiltrated with 5 cc of 1% lidocaine plain. A 20 gauge Tuohy needle was then inserted and directed towards the L5-S1 interspace. Then using fluoroscopic guidance and loss of resistance technique, the needle was inserted into the epidural space, negative aspirate for CSF or blood, 80 mg of Depo-Medrol and 2 cc of sterile saline, both preservative–free, were injected into the epidural space without complications. The patient tolerated the procedure well.
CODES :
Cpt: 64483 , Dx-724.02 , Px-03.92.
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5#
5#
PREOPERATIVE DIAGNOSIS: Cervical radiculopathy.
POSTOPERATIVE DIAGNOSIS: Cervical radiculopathy.
PROCEDURE PERFORMED: Right C7-C8 & C8-T1 transforaminal epidural steroid injection.
DESCRIPTION OF PROCEDURE: A PAR conference was held with the patient. She agreed to the procedure and placed in the prone position. Back prepped three times with Betadine paint. Her pain is right C7-C8 and C8-T1 distribution. She has severe stenosis at right C7-C8 and C8-T1. Transforaminal spread was seen with 1 cc of Omnipaque-300 and washed out under live fluoroscopy with 12 mg of Celestone and 1 cc of 1% lidocaine. The patient tolerated the procedure well and discharged in good condition with instructions for followup.
CODES :
Cpt: 644879& 64480 , Dx-723.4 , Px-03.92.
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6#
PREOPERATIVE DIAGNOSIS: Lumbar radiculopathy.
6#
PREOPERATIVE DIAGNOSIS: Lumbar radiculopathy.
POSTOPERATIVE DIAGNOSIS: Lumbar radiculopathy.
PROCEDURE PERFORMED: Right L4-L5 & L5-S1 transforaminal epidural steroid injection
DESCRIPTION OF PROCEDURE: A PAR conference was held with the patient. She agreed to the procedure and placed in the prone position. Back prepped three times with Betadine paint. Her pain is right L4-L5 & L5-S1 distribution. She has severe stenosis at right L4-L5 & L5-S1 . After sterile prep and drape, a 1% lidocaine infiltrated and #22-gauge 5-inch needle advanced to the right L4-L5 & L5-S1 foramen. Transforaminal spread was seen with 1 cc of Omnipaque-300 and washed out under live fluoroscopy with 12 mg of Celestone and 1 cc of 1% lidocaine. The patient tolerated the procedure well and discharged in good condition with instructions for followup.
CODES :
Cpt: 64483 & 64484 , Dx-724.4 , Px-03.92.
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