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I also use this technique for thoracic RFA. Quick, safe and it works.
Techniques and Pearls for Thoracic MBB/RFA
Started by cameroncarter
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I also use this technique for thoracic RFA. Quick, safe and it works.
Whoever wants my thoracic anything procedures, send me your contact info, happy to send. For the n, it’s just not worth the time, insurance ridiculousness, effort, risk etc.
I say this as I have multiple legacy thoracic epidural, thoracic rfa pateints that I begrudgingly do mainly because they have Medicare and I have no interest in taking on any new patients in this category
I say this as I have multiple legacy thoracic epidural, thoracic rfa pateints that I begrudgingly do mainly because they have Medicare and I have no interest in taking on any new patients in this category
Let me see if you can guess who I am “Your anecdotes and n of 10 mean nothing to me. Show me the DBRCTs” 😜
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Ok guys. The pedicle shadow and the S1 tfesi’s both work quite well.
Not sure about deac, but I “liked” the post as a good natured jab at Steve.
Deac is right that Steve always “insists” on level 1-2 evidence, but Steve’s post (#100) does seem to conveniently forgot about that principle…..
I don’t live near you and I don’t need anymore patients.
However, I’d rather do thoracic ESI and thoracic RFA over CESI and cervical RFA.
Pays the same and is safer and quicker. (At least with the thoracic RFA technique that Steve and I both use).
I’ve had issues with many BCBS plans not covering thoracic RFA, but no issues with straight Medicare, Cigna, Aetna, UHC, or our state WC.
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I insert midline and basically follow SP with Sidekick tip like so. I feel like it's actual quite parallel. Whether it's distal to articular branches that's up for debate, but seems to work well anecdotally.
The needles I’m seeing people post look more like this. What your showing is similar to how I place my needles
Ok even safer than trying to find the TP
So I have been revieing this thread...just confirming you only do pedicle shadow for T10 MBB and above. T11 and below is traditional target Junction of the SAP and TP based on the anatomy and the course of the Medial branches.
For Pedicle shadow technique you start one level below, go in medial to lateral and land on the upper outer quadrant of the pedicle shadow.
I guess my question is for the Pedicle shadow technique do you do this pretty much from an AP approach?
For Pedicle shadow technique you start one level below, go in medial to lateral and land on the upper outer quadrant of the pedicle shadow.
I guess my question is for the Pedicle shadow technique do you do this pretty much from an AP approach?
Yes, I do AP using the pedicular shadow technique.
on your AP when you are placing the needles using the pedicular shadow technique, are you putting on any caudal tilt or just 0 degrees AP and then climbing up starting one level below? Have an upcoming T8, T9, T10 RFA. Okay to use 18g venom needles? @lobelsteve @drmamba
I caudal tilt to square endplates. Start at inferior VB plate and head superiolateral. Nothing but skin/fat/muscle- if skinny patient risk of skin burn based on depth.
Probably dumb questions but honestly curious. do people actualy document this pedicle shadow technique on procedure note officially..is it an accepted way to do the procedure. it seems well accepted on this forum but is there any pubnlished literature on it. Curious as I have dont only a few thoracic RFAs, 99% of my RFA are cervical and lumbar.
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I average 1/week, did two today.
This is the snippet of our note, no issues billing or legality
Procedure in Detail : … A curved radio frequency cannula 20 gauge, 10 cm was placed at the appropriate level, at each site. Multiplanar views were used to confirm placement of the needle and motor was tested at each individual level…
I’ve been contemplating scraping thoracic rfa and just doing sprint SPR… it takes like 5 minutes and a nice filler at the asc
Thoughts?
Thoughts?
I’ve never done Sprint in the T spine. I am assuming you would just place the lead at the pedicle shadow for this technique?
One issue I see is which ICD10 code would you use? In the L spine I have been using the lumbar multifidus dysfunction code.
G58.8 other specified mononeuropathy
Just to play devils advocate, do you really feel that there is a neuropathy of the medial branch nerve in this case? I would assume most of us would be doing the procedure to help with pain presumably from spondylosis. I think using that diagnosis code is a bit of a gray area. I am not criticizing you or anything, just putting my thoughts out there.
Is there a closer/more appropriate code that’s an acceptable Medicare PNS code?
Not that I can find. That is the problem that I am running in to. I think the therapy could potentially help but I am not really comfortable using a diagnosis code that I don’t think is accurate or appropriate.
reminds me of docs using CRPS codes for knee pain after TKA to get DRG approved
I agree 100%.
It’s the closest one. Lumbar spondy is not an approved icd10 for Medicare
Can’t you use this for lumbar region?
Not covered for my lcd
This what I use for the lumbar region, yes. There is no analogous covered code for the thoracic region, however.
Does everyone do these with 18g 100mm length needles? Anyone do these with 20g? How about yellow 150mm length? Have one coming up tomorrow and going to utilize the pedicle shadow technique
18
Depends on body habitus re 100 vs 150
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16g cooled
18 100 you’ll have tons of length remaining
What length active tip do you use for this? And what minimum depth do you like your tip to be to avoid risk of skin burns?
Any concern with thoracic RFA at T8-T10 with SCS leads around those levels. Device will of course be shut off prior.
no issues, do it all the time
