The podiatrist submitted 20605 for this note but other than midfoot,
there aren't any other anatomical landmarks to support where the
injection was directed. Would this support a 20605? I have another
note that states he injected the foot with the same documentation
(fanning, etc.) because of a neuroma but he billed a 64450 for that one
instead. In both cases I don't feel there's enough info to support
anything other than a 96372. Any other opinions? Thanks-Sue
Assessment: L foot post traumatic midfoot arthritis with extensor/peroneal atrophy with mild foot drop to the L foot/leg
3) Injection therapy was performed today with a combination of long and short acting steroids, and with a long acting local anesthetic. The patient was given an injection into the L dorsal midfoot using 1cc 0.5% Bupivicaine (5mg/ml) plain and with 1cc of Depo-Medrol (methylprednisolone acetate) 80mg/ml, 1cc of Dexamethasone Sodium Phosphate 4mg/ml. This was injected under sterile technique, and was then fanned out through the region. The site was then dressed with a Band-Aid.
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A logic guess is this could be a nerve block procedure, since Bupivicaine is one of the drugs used for nerve block procedures, and peroneal atrophy affects the peripheral nerves, known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy.
It is my suggestion to query the provider...
rsmallcanyon, RHIT, CPC
Source: http://www.aapc.com/memberarea/forums/showthread.php?s=303aa32072c4a2d8f4ed3577ae2439ec&t=101636
Assessment: L foot post traumatic midfoot arthritis with extensor/peroneal atrophy with mild foot drop to the L foot/leg
3) Injection therapy was performed today with a combination of long and short acting steroids, and with a long acting local anesthetic. The patient was given an injection into the L dorsal midfoot using 1cc 0.5% Bupivicaine (5mg/ml) plain and with 1cc of Depo-Medrol (methylprednisolone acetate) 80mg/ml, 1cc of Dexamethasone Sodium Phosphate 4mg/ml. This was injected under sterile technique, and was then fanned out through the region. The site was then dressed with a Band-Aid.
Reply
A logic guess is this could be a nerve block procedure, since Bupivicaine is one of the drugs used for nerve block procedures, and peroneal atrophy affects the peripheral nerves, known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy.
It is my suggestion to query the provider...
rsmallcanyon, RHIT, CPC
Source: http://www.aapc.com/memberarea/forums/showthread.php?s=303aa32072c4a2d8f4ed3577ae2439ec&t=101636
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