cmullins
Guest
I'm fairly new to neurosurgery billing, so would appreciate some help!
The doc did a Right L4-5 microlumbar foraminal decompression (63042) and endplate biopsy (cpt?). I'm having trouble deciding which code to use for the biopsy. An incision was made over the right L4-5 interspace using lateral fluoroscopic guidance, and then incised the fascia below it and used serial dilation to place a 5cm METRx tube over the back of the right L4-5 interspace. Once the joint was identified used cautery to clean some fatty tissue off the back of the joint. Then used 3mm Kerrison after stripping away scar tissue from the lamina to continue removing lamina and medial facet. The synovium encountered appeared unhealthy without any overt sign of infection and the bone itself was soft. Then got down to the lateral canal and disc space lateral to the L5 nerve. After opening the disc space with the Penfield 4, passed the pituitary rongeur into the disc space and pulled out pieces of the disc for microbiology culture. Then used fluoro to confirm where she was in the disc space and tried to take different passes into the different areas of the disc and grab pieces of what appeared to be gelatinous disc. Then went along the L4 endplate which was able to be felt with the pituitary rongeur and got fluoroscopic confirmation that was where she was and then also scraped along the side of the endplate to grab some of the soft bone for culture as well.
Proceeded with decompression of the L4 nerve. Worked her way up slightly higher in the lateral canal and worked to remove medial facet joint until identified what at first appeared to be the L4 nerve. Removed some ligament from behind it and followed this out laterally undercutting and removing ligament and bone until nerve hook could be run along the trajectory. This then appeared to be sheet of vascular tissue over the back of the nerve which could slide under and lift with the nerve hook. At this point could feel out the neural foramen both with the nerve hook and with the flat dissector. [/I]
I was thinking of using 20251, but like I said, I'm very new at this. Any suggestions/help?
The doc did a Right L4-5 microlumbar foraminal decompression (63042) and endplate biopsy (cpt?). I'm having trouble deciding which code to use for the biopsy. An incision was made over the right L4-5 interspace using lateral fluoroscopic guidance, and then incised the fascia below it and used serial dilation to place a 5cm METRx tube over the back of the right L4-5 interspace. Once the joint was identified used cautery to clean some fatty tissue off the back of the joint. Then used 3mm Kerrison after stripping away scar tissue from the lamina to continue removing lamina and medial facet. The synovium encountered appeared unhealthy without any overt sign of infection and the bone itself was soft. Then got down to the lateral canal and disc space lateral to the L5 nerve. After opening the disc space with the Penfield 4, passed the pituitary rongeur into the disc space and pulled out pieces of the disc for microbiology culture. Then used fluoro to confirm where she was in the disc space and tried to take different passes into the different areas of the disc and grab pieces of what appeared to be gelatinous disc. Then went along the L4 endplate which was able to be felt with the pituitary rongeur and got fluoroscopic confirmation that was where she was and then also scraped along the side of the endplate to grab some of the soft bone for culture as well.
Proceeded with decompression of the L4 nerve. Worked her way up slightly higher in the lateral canal and worked to remove medial facet joint until identified what at first appeared to be the L4 nerve. Removed some ligament from behind it and followed this out laterally undercutting and removing ligament and bone until nerve hook could be run along the trajectory. This then appeared to be sheet of vascular tissue over the back of the nerve which could slide under and lift with the nerve hook. At this point could feel out the neural foramen both with the nerve hook and with the flat dissector. [/I]
I was thinking of using 20251, but like I said, I'm very new at this. Any suggestions/help?