Hello all my surgeon like to code 63047 with 63035x2 bilateral which I know is incorrect. can someone please help me with this coding. here's the procedure:
Dx: Lumber stenosis and spondylosis
Bilateral L3-4 and L4-5 hemilaminotomies for microdecompression.
2. Left L5-S1 hemilaminectomy and right L5-S1 hemilaminotomy for
decompression.
Report:
The patient and his wife were met prior to surgery
and all questions were answered. He was brought back to the operating room
where he was placed under general endotracheal anesthesia while supine on
the hospital gurney. He was then carefully rotated to the prone position
on top of the Wilson frame with all pressure points padded adequately. The
Wilson frame was cranked up to provide gentle flexion of his lumbar spine.
His lower back was then prepped and draped in standard surgical fashion.
A final timeout was performed before 10 mL of 0.5% Marcaine with
epinephrine was injected along the planned incision site. Incision was
then made from the L3 spinous process down to the S1 spinous process.
Bovie electrocautery was used for hemostasis and to dissect down to the
posterior lumbar fascia.
A subperiosteal dissection was carried out along out along the spinous
processes and lamina of L3 through S1 bilaterally. A #1 Penfield marker
was placed in the interlaminar space at L5-S1 and x-ray obtained which
confirmed its position at that level.
Retractors were then placed and the microscope was draped and brought into
the field for microdissection. Starting on the left side at L3-4, a
hemilaminotomy and medial facetectomy was performed using the pneumatic
drill and Kerrison rongeurs. Thickened ligamentum flavum was removed. We
decompressed laterally to the medial edge of the L4 pedicle. Gelfoam and
thrombin were then placed for hemostasis.
We turned our attention to the right side where the procedure was repeated
at L3-4. We then moved down to L4-L5 on the left. This level was noted to
have the most severe stenosis, and a wider hemilaminotomy was performed
starting on the left. The bone was extremely thickened, and upon reaching
the ligament the ligament appeared to be very diseased as it had a greenish
brown color. This is evidence of possible microhemorrhages.
We very carefully debulked the thickened ligamentum flavum and decompressed
the bony anatomy laterally to the medial edge of the L5 pedicle. In some
areas the ligament was extraordinarily stuck to the dura, and we actually
had to start the L5 laminotomy. Given the extraordinarily stuck ligament to
the dura at the junction of L5 and L4, a complete hemilaminectomy was
performed on the left of L5. The ligament was then carefully teased off of
the dura and we had a good decompression. At this time, I completed the
medial facetectomy on the left at L5-S1 with Kerrison and Kerrison
rongeurs. Gelfoam and thrombin were then placed for hemostasis.
We turned our attention to the right side where again a hemilaminotomy was
performed at L4-5 on the right. Significantly thickened ligament was
removed. Some of the ligament was completely stuck to the dura, so I had to
leave a small amount in the lateral recess, but it was not creating any
pressure.
We then turned our attention to L5-S1 where a hemilaminotomy was performed
in the same manner. The lateral recess was decompressed.
The wound was copiously irrigated with antibiotic irrigation. Gelfoam and
thrombin were used for hemostasis; 62.5 mg of Solu-Medrol and 4 mg of
Duramorph were placed in the epidural space. The retractors were removed
and the wound was closed in layers with 0 Vicryl suture for the fascia and
inverted 2-0 Vicryl suture for the deep cutaneous layer. A running
subcuticular 3-0 Quill Monocryl was used to close the skin. Mastisol,
Steri-Strips, and a sterile dressing was applied.
Dx: Lumber stenosis and spondylosis
Bilateral L3-4 and L4-5 hemilaminotomies for microdecompression.
2. Left L5-S1 hemilaminectomy and right L5-S1 hemilaminotomy for
decompression.
Report:
The patient and his wife were met prior to surgery
and all questions were answered. He was brought back to the operating room
where he was placed under general endotracheal anesthesia while supine on
the hospital gurney. He was then carefully rotated to the prone position
on top of the Wilson frame with all pressure points padded adequately. The
Wilson frame was cranked up to provide gentle flexion of his lumbar spine.
His lower back was then prepped and draped in standard surgical fashion.
A final timeout was performed before 10 mL of 0.5% Marcaine with
epinephrine was injected along the planned incision site. Incision was
then made from the L3 spinous process down to the S1 spinous process.
Bovie electrocautery was used for hemostasis and to dissect down to the
posterior lumbar fascia.
A subperiosteal dissection was carried out along out along the spinous
processes and lamina of L3 through S1 bilaterally. A #1 Penfield marker
was placed in the interlaminar space at L5-S1 and x-ray obtained which
confirmed its position at that level.
Retractors were then placed and the microscope was draped and brought into
the field for microdissection. Starting on the left side at L3-4, a
hemilaminotomy and medial facetectomy was performed using the pneumatic
drill and Kerrison rongeurs. Thickened ligamentum flavum was removed. We
decompressed laterally to the medial edge of the L4 pedicle. Gelfoam and
thrombin were then placed for hemostasis.
We turned our attention to the right side where the procedure was repeated
at L3-4. We then moved down to L4-L5 on the left. This level was noted to
have the most severe stenosis, and a wider hemilaminotomy was performed
starting on the left. The bone was extremely thickened, and upon reaching
the ligament the ligament appeared to be very diseased as it had a greenish
brown color. This is evidence of possible microhemorrhages.
We very carefully debulked the thickened ligamentum flavum and decompressed
the bony anatomy laterally to the medial edge of the L5 pedicle. In some
areas the ligament was extraordinarily stuck to the dura, and we actually
had to start the L5 laminotomy. Given the extraordinarily stuck ligament to
the dura at the junction of L5 and L4, a complete hemilaminectomy was
performed on the left of L5. The ligament was then carefully teased off of
the dura and we had a good decompression. At this time, I completed the
medial facetectomy on the left at L5-S1 with Kerrison and Kerrison
rongeurs. Gelfoam and thrombin were then placed for hemostasis.
We turned our attention to the right side where again a hemilaminotomy was
performed at L4-5 on the right. Significantly thickened ligament was
removed. Some of the ligament was completely stuck to the dura, so I had to
leave a small amount in the lateral recess, but it was not creating any
pressure.
We then turned our attention to L5-S1 where a hemilaminotomy was performed
in the same manner. The lateral recess was decompressed.
The wound was copiously irrigated with antibiotic irrigation. Gelfoam and
thrombin were used for hemostasis; 62.5 mg of Solu-Medrol and 4 mg of
Duramorph were placed in the epidural space. The retractors were removed
and the wound was closed in layers with 0 Vicryl suture for the fascia and
inverted 2-0 Vicryl suture for the deep cutaneous layer. A running
subcuticular 3-0 Quill Monocryl was used to close the skin. Mastisol,
Steri-Strips, and a sterile dressing was applied.