a patient has had short term relief with 3 occ nerve blocks to the lesser occ nerve. anyone out there done pulsed rf to that area?
the patient shys away from implantableslobelsteve said:Have not RF'd it but have had a decent case series of patients (8-10) with a single quatrode or octrode from the mastoid running inferomedially go to implantation with very happy patients at 6 mo follow up.
jsaul said:the patient shys away from implantables
2 things--- #1 cryo usually lasts only 3 weeks--- I have heard some success with pulsed rf lasting much longerC Fiber said:Try Cryo?
algosdoc said:And how does one bill for a pulsed RF of the occipital nerve?
algos, have you done pulsed rf to the greater or lesser occ nerve? Just wondering what your thoughts were on that. Understand your point on the billing issue. but please expand on the actual procedurealgosdoc said:And how does one bill for a pulsed RF of the occipital nerve?
algosdoc said:The real question becomes whether 43 degrees results in protein degradation, cellular destruction, or neurodestruction.
Pulsed RF as defined by the CPT committee of the AMA is coded 64999. There are no exceptions for bumping the temperature to 43 degrees, which is still 40 deg C away from the common temperatures used in neuroablative procedures during RFTC.
ETOH 50-100%, 4cc. 1cc lido ahead of the ETOH.
n of 5-6 for GON. I use 98% ETOH.
Ok, I already did 50% etoh. I did a cc or two of lido and bupiv before it and he had no pain for about 12 hrs then it returned. Maybe I had a bad batch of etoh? Anyway, was going to try and stim it to find the closest spot and then either pulse or burn. I dunno... if that doesn't work I was going to hit the nerve down at C2/3 diagnostically and then burn there. If that didn't work, occipital stim even tho I've never done one. Can't be that hard right? Tunnel with a touhy right under the skin and go from mastoid up to occipital protuberance?
Are you US or stimming to find an exact spot, or do you infiltrate?
As above, deafferentation complications with etoh on peripheral nerves?
I regularly etoh scar neuroma type pain, but havejn't pulled the trigger on a peripheral nerve outside terminal cancer.
Did one of these about 3 mo ago. Pain returned, so my colleague advised a heat lesion, which he did earlier this week. I will report back when we see her in follow-up.What about RF the TON?
On the occasions that I consider a PRF of C2 I usually do it as part of a C2 TFESI and just bill for the injection.
This is called the "Dutch Technique" and if it works you can claim that PRF is an effective modality and ignore the fact that you injected a steroid as well (not that I'm cynical or anything).
Did one of these about 3 mo ago. Pain returned, so my colleague advised a heat lesion, which he did earlier this week. I will report back when we see her in follow-up.