MBB injectate?

[FSQT]

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So y'all just burning that C2 medial branch to treat occipital neuralgia, or what?

 

[Ducttape]

are people confusing the supposed C2 medial branch with the TON?

 

[Orin]

are people confusing the supposed C2 medial branch with the TON?

I've seen a few people think that they must burn two separate locations on C2, billing separately for a TON burn.

In-vitro study of the third occipital nerve near the C2-3 facet joint and the association between its morphology and the presence of a third occipital nerve notch - PMC

Occipital neuralgia, a debilitating condition characterized by headaches and neck pain, has been linked to the third occipital nerve (TON). Despite its potential role in this condition, the TON's relationship with surrounding structures, ...

pmc.ncbi.nlm.nih.gov

I assume they don't appreciate that most studies show the TON to be the primary contribution to the superior half innervation to the C2/C3 joint🤷‍♂️

 

[kstarm]

In the past I would have issues with insurance companies denying 3rd occipital nerve ablations but be totally fine with "C2 medial branch" ablations. So now my note usually states both

 

[Greenbayslacker]

0.5% bupi + dex

 

[Greenbayslacker]

0.25% marcaine for everything except C2. I use lido there. had 3 seconds of sudden asystole immediately after injecting C2 MBN for an RFA with 1 cc of 0.25%. had to have been vascular uptake but aspiration was negative. weird.

You're doing EKG monitoring during RFA?

 

[Taus]

In the past I would have issues with insurance companies denying 3rd occipital nerve ablations but be totally fine with "C2 medial branch" ablations. So now my note usually states both

For consistency with the patient, office notes, imaging, schedulers and prior authorization, I just write “medial branches to the X facet joint”. Also avoids the confusion in T/L spine for joint level vs nerve level discrepancies. Examples, L45 facet joint coded properly as L3/4 mb, denied if L34 is fused. T12-L1 facet, T11/12 mb denied by commercial ins as not covered above t12-l1, ton denied as above. Also if its to be done by one of my partners or referred to me… just avoids the possible confusion.