Number: 0934 Policy Aetna considers epidural blood patching (EBP) medically necessary for the treatment of post-dural puncture headache (PDPH) if member exhibited prolonged headaches (greater than 24 hours). Aetna considers EBP for the treatment of spontaneous intracranial hypotension if any of the following selection criteria is met: • An aggressive precipitating injury, a history of connective tissue disease, or joint hypermobility; or • Headache unresponsive to a reasonable period of conservative treatment (e.g., bed rest and oral analgesics for 1 to 2 weeks); or • Severe headache or other disabling symptoms, regardless of duration; or • Symptomatic for 2 weeks or longer at the time of diagnosis. Aetna considers the following experimental and investigational because the effectiveness of these approaches has not been established: • Prophylactic EBP • EBP for the treatment of post-dural puncture tinnitus • Epidural fibrin glue patching for the treatment of PDPH • Epidural autologous platelet-rich-plasma patching for the treatment of PDPH. Background Epidural Blood Patching (EBP) for the Treatment of Post-Dural Puncture Headache Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater. The headache can be severe and it entails the back and front of the head, and spreading to the neck and shoulders, sometimes involving neck stiffness. It is exacerbated by movement, and sitting or standing, and relieved to some degree by lying down. ![]() Blood Patch Icd 10Nausea, vomiting, pain in arms and legs, hearing loss, tinnitus, vertigo, dizziness and paraesthesia of the scalp are common. It is a common side-effect of spinal anesthesia and lumbar puncture and may occasionally accidentally occur in epidural anesthesia. Leakage of cerebrospinal fluid (CSF) through the dura mater puncture causes reduced fluid levels in the brain and spinal cord, and may lead to the development of PDPH hours or days later. Some individuals require no other treatment than pain medications and bed rest. Persistent and severe PDPH may require an epidural blood patching (EBP), which entails injection of a small amount of autologous blood into the epidural space to stop certain types of spinal headaches. Cpt For Blood Alcohol TestBlood Groups: Section 231.4 directs hospitals to report HCPCS code P9011 (Blood (split unit), specify amount) for the blood product transfused as well as CPT 86985 (Splitting of blood or blood products, each unit) for each splitting procedure performed to prepare the blood product for a specific patient. We have received feedback from hospitals expressing concern that reporting in this manner will have a negative impact on reimbursement. The procedure is coded as 62273* (injection, epidural, of blood or clot patch). An ASA crosswalk code does not exist because most patients do not require anesthesia during the procedure. And, because in most cases the anesthesiologist performs the blood patch instead of administering anesthesia for another physician to do it, you use the. This resulting blood clot patches the hole in the spine and treats the patient’s headache symptoms. It is also believed that EBP causes compression and relieves the pressure state in the head, which causes the headache. In a very small percentage of cases, the headache can recur, and EBP may need to be repeated. Epidural blood patching is generally well-tolerated, and has a low incidence of complications, which include slight back pain, stiffness in the neck and low-grade fever. Success rates of EBP varying from 60 to 95% have been reported; this variability may be a consequence of a higher efficacy rate when EBP is used for small dural punctures. Epidural blood patching usually takes approximately 15 minutes and is carried out in an out-patient setting (No authors listed, 2001; Turnbull and Shepherd, 2003). In a Cochrane review, Boonmak and Boonmak (2010) examined the possible benefits and harms of EBP in both prevention and treatment of post-dural puncture headache (PDPH). These investigators searched the Cochrane PaPaS Group Trials Register; CENTRAL; Medline and Embase in April 2009. They sought all randomized controlled trials (RCTs) that compared EBP versus no EBP in the prevention or treatment of PDPH among all types of participants undergoing dural puncture for any reason. One review author extracted details of trial methodology and outcome data from studies considered eligible for inclusion. These researchers invited authors of all such studies to provide any details that were unavailable in the published reports. They performed intention-to-treat (ITT) analyses using the Peto O-E method. They also extracted information about adverse effects (AEs; post-dural puncture backache and epidural infection). A total of 9 studies (379 participants) were eligible for inclusion. Prophylactic EBP improved PDPH compared to no treatment (odds ratio [OR] 0.11, 95% confidence interval [CI]: 0.02 to 0.64, 1 study), conservative treatment (OR 0.06, 95% CI: 0.03 to 0.14, 2 studies) and epidural saline patch (OR 0.16, 95% CI: 0.04 to 0.55, 1 study). ![]() However, prophylactic EBP did not result in less PDPH than a sham procedure (1 study). Therapeutic EBP resulted in less PDPH than conservative treatment (OR 0.18, 95% CI: 0.04 to 0.76, 1 study) and a sham procedure (OR 0.04, 95% CI: 0.00 to 0.39, 1 study). Backache was more common with EBP. However, these studies had very small numbers of participants and outcome events, as well as uncertainties about trial methodology, which precluded reliable assessments of the potential benefits and harms of the intervention. The authors did not recommend prophylactic EBP over other treatments because there were too few trial participants to allow reliable conclusions to be drawn. Software to hack computer using ip address. However, therapeutic EBP showed a benefit over conservative treatment, based on the limited available evidence. Gottschalk (2015) stated that in most cerebro-spinal fluid (CSF) leaks are iatrogenic and caused by medical interventions (e.g., lumbar puncture, peri-dural anesthesia and surgical interventions on the spine). However, spontaneous cerebral hypotension is currently detected more frequently due to improvements in diagnostic possibilities but often the cause cannot be clarified with certainty. There are various diagnostic tools for confirming the diagnosis and searching for the site of CSF leakage, such as postmyelography computed tomography (postmyelo-CT), indium-111 radioisotope cisternography and (myelo) magnetic resonance imaging (MRI), which show different sensitivities. In accordance with the authors’ experience, native MRI with fat-saturated T2-weighted sequences is often sufficient for diagnosing CSF leakage and the site. For the remaining cases, an additional postmyelo-CT or alternatively myelo-MRI is recommended.
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