dsibley67
Networker
I need help choosing which is the correct code for this procedure. I am torn between 63662 & 63688. The thing that is throwing me off is 63662 says via laminotomy/laminectomy. When you read the description of 63662, it says previously placed through laminotomy or laminectomy, which removed either the entire lamina or part of the lamina, which was the original procedure. He also performed a thoracic laminectomy when removing the neurostimulator. Maybe I just read too much into these codes, but they confuse the heck out of me. I hope this makes sense. Any help will be greatly appreciated! Thanks!
PROCEDURES PERFORMED:
1. Removal of spinal cord stimulator paddle and generator lead.
2. T10 laminectomy
INDICATIONS FOR PROCEDURE
The spinal cord stimulator has
lost its effectiveness and it was no longer being used. He elected to have it removed so we could move
forward with MRI and other potential surgical options. Prior to the procedure, he was made aware of the
risks and expectations. He signed informed consent to move forward with the procedure.
I marked the skin overlying the generator in his right flank as well as in the midline at the location
of the paddle lead. The skin was then anesthetized and sharply incised in the right flank. I easily
expressed the generator. The leads were cut. I then turned my attention to the thoracic location. This
area was incised. Bovie cautery was used for hemostasis. I dissected down onto the remaining spinous
processes and lamina and a self-retaining retractor was placed. I pulled the leads into the upper wound
from the lower wound. I dissected down to the entry point of the paddle lead, within the canal he had
some bony overgrowth in that area and I could not safely undermine this without damaging the lead or
paddle. I therefore used a bone scalpel to cut the T10 lamina bilaterally. I removed the lower two-thirds
of the T10 lamina. This section of bone was mobilized with an osteotome and undercut with a curette.
Once this was completed, I could then identify the scar tissue surrounding the paddle lead. This was
divided with a Kerrison rongeur and the paddle lead was removed without complication. There was no
sign of CSF leak. I copiously irrigated the wound with antibiotic saline solution. There was no bleeding
noted and I did not utilize the drain. We closed the fascia with interrupted 0 Vicryl suture. Both wounds
were closed with subcutaneous 2-0 Vicryl and the skin was dressed with staples. Soft sterile dressings
were placed. He tolerated the procedure well without apparent complication.
PROCEDURES PERFORMED:
1. Removal of spinal cord stimulator paddle and generator lead.
2. T10 laminectomy
INDICATIONS FOR PROCEDURE
The spinal cord stimulator has
lost its effectiveness and it was no longer being used. He elected to have it removed so we could move
forward with MRI and other potential surgical options. Prior to the procedure, he was made aware of the
risks and expectations. He signed informed consent to move forward with the procedure.
I marked the skin overlying the generator in his right flank as well as in the midline at the location
of the paddle lead. The skin was then anesthetized and sharply incised in the right flank. I easily
expressed the generator. The leads were cut. I then turned my attention to the thoracic location. This
area was incised. Bovie cautery was used for hemostasis. I dissected down onto the remaining spinous
processes and lamina and a self-retaining retractor was placed. I pulled the leads into the upper wound
from the lower wound. I dissected down to the entry point of the paddle lead, within the canal he had
some bony overgrowth in that area and I could not safely undermine this without damaging the lead or
paddle. I therefore used a bone scalpel to cut the T10 lamina bilaterally. I removed the lower two-thirds
of the T10 lamina. This section of bone was mobilized with an osteotome and undercut with a curette.
Once this was completed, I could then identify the scar tissue surrounding the paddle lead. This was
divided with a Kerrison rongeur and the paddle lead was removed without complication. There was no
sign of CSF leak. I copiously irrigated the wound with antibiotic saline solution. There was no bleeding
noted and I did not utilize the drain. We closed the fascia with interrupted 0 Vicryl suture. Both wounds
were closed with subcutaneous 2-0 Vicryl and the skin was dressed with staples. Soft sterile dressings
were placed. He tolerated the procedure well without apparent complication.