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Caudal Epidural Steroid Injection under Fluoroscopic Guidance
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PREOPERATIVE DIAGNOSIS:
• • •
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POSTOPERATIVE DIAGNOSIS:
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Epidurogram
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CPT CODES:
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Epidurogram CPT (MM 76000) (WC/NF 72275)
• • •
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Sedation
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Sedation
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ANESTHETIC AGENT:
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MEDICATION:
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NEEDLE UTILIZED:
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PROCEDURE
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with Epidurogram
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SURGEON:
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MEDICAL NECESSITY
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Necessity
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number of procedure
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Notes
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PROCEDURE IN DETAIL
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Procedure Details
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I injected 1cc of ____
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Injected a total of
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Notes
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Epidurogram
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Epidurogram
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RECOVERY
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Recovery details
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Notes
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Antoniou
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Antoniou
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Bracco
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Bracco
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