Physician performs bilateral Bone Marrow Biopsy of L5 pedicles and then performs vertebroplasty on L5. I know deep bone biopsy is considered bundled into the vertebrolpasty procedure code. However what about Bone Marrow Biopsy? Can this be coded as 22511 and 38221 (38221-50?) 77002. Let me know your thoughts.
The right pedicle of L5 was identified in an oblique fashion and 0.75% Marcaine was infiltrated into the skin and subcutaneous tissues and paraspinal muscle and right pedicle of L5 utilizing a 25-gauge needle then 22-gauge needle then 22-gauge spinal needle. Small incision was made in the skin using 11 blade. The 11-gauge bone marrow biopsy trocar needle was advanced down under fluoroscopy, just beneath the superior endplate of L5 and into the vertebral body. A bone marrow biopsy specimen was obtained and placed in a container of formaldehyde and sent to histology for evaluation. This specimen measured approximately 3 mm in length. The vertebroplasty 11-gauge trocar needle was then advanced down under fluoroscopy until it was in the mid superior aspect of 05. Spot images were obtained confirming the position of the needle within the L5 vertebral body.
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My attention then turned to the left pedicle of L5. In an oblique fashion, the left pedicle of L5 was identified and 0.75% Marcaine was infiltrated into the skin and subcutaneous tissues and paraspinal muscle and left pedicle utilizing a 25-gauge then 22-gauge then 22-gauge spinal needle. A small incision was made in the skin using 11 blade. The bone marrow biopsy needle was then advanced down. This was advanced into the mid aspect of the L5 vertebral body and a 5 mm long core of bone marrow was obtained from the site. This specimen was placed in a separate container of formaldehyde and sent to histology for evaluation. Next the vertebroplasty 11-gauge trocar needle was advanced down through the left pedicle L5 until the tip of the needle was in the anterior inferior aspect of L5. Spot images were obtained confirming the position of the needle within the vertebral body.
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Next the PMMA barium sulfate mixture was mixed and each cannula was then flushed with normal saline. As the left cannula was slightly withdrawn 4.5 mL of PMMA barium sulfate mixture was placed into the L5 vertebral body. In a similar fashion 3.0 mL was placed on the right. The stylets were able to be completely replaced.
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The L5 vertebral body was completely filled with the PMMA barium sulfate mixture and reexpanded the superior endplate slightly. No extravasation outside of the L5 vertebral body was noted. The needles were withdrawn and fingertip pressure held over the puncture site and good hemostasis was obtained. The back was cleansed and dried and 4 sided Band-Aids placed over the incision sites.
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Spot images were then obtained showing the excellent filling of the L5 vertebral body with no extravasation outside of the L5 vertebral body. Patient tolerated the procedure well and there were no immediate complications. The patient was returned to Outpatient Surgery for further recovery.
The right pedicle of L5 was identified in an oblique fashion and 0.75% Marcaine was infiltrated into the skin and subcutaneous tissues and paraspinal muscle and right pedicle of L5 utilizing a 25-gauge needle then 22-gauge needle then 22-gauge spinal needle. Small incision was made in the skin using 11 blade. The 11-gauge bone marrow biopsy trocar needle was advanced down under fluoroscopy, just beneath the superior endplate of L5 and into the vertebral body. A bone marrow biopsy specimen was obtained and placed in a container of formaldehyde and sent to histology for evaluation. This specimen measured approximately 3 mm in length. The vertebroplasty 11-gauge trocar needle was then advanced down under fluoroscopy until it was in the mid superior aspect of 05. Spot images were obtained confirming the position of the needle within the L5 vertebral body.
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My attention then turned to the left pedicle of L5. In an oblique fashion, the left pedicle of L5 was identified and 0.75% Marcaine was infiltrated into the skin and subcutaneous tissues and paraspinal muscle and left pedicle utilizing a 25-gauge then 22-gauge then 22-gauge spinal needle. A small incision was made in the skin using 11 blade. The bone marrow biopsy needle was then advanced down. This was advanced into the mid aspect of the L5 vertebral body and a 5 mm long core of bone marrow was obtained from the site. This specimen was placed in a separate container of formaldehyde and sent to histology for evaluation. Next the vertebroplasty 11-gauge trocar needle was advanced down through the left pedicle L5 until the tip of the needle was in the anterior inferior aspect of L5. Spot images were obtained confirming the position of the needle within the vertebral body.
*
Next the PMMA barium sulfate mixture was mixed and each cannula was then flushed with normal saline. As the left cannula was slightly withdrawn 4.5 mL of PMMA barium sulfate mixture was placed into the L5 vertebral body. In a similar fashion 3.0 mL was placed on the right. The stylets were able to be completely replaced.
*
The L5 vertebral body was completely filled with the PMMA barium sulfate mixture and reexpanded the superior endplate slightly. No extravasation outside of the L5 vertebral body was noted. The needles were withdrawn and fingertip pressure held over the puncture site and good hemostasis was obtained. The back was cleansed and dried and 4 sided Band-Aids placed over the incision sites.
*
Spot images were then obtained showing the excellent filling of the L5 vertebral body with no extravasation outside of the L5 vertebral body. Patient tolerated the procedure well and there were no immediate complications. The patient was returned to Outpatient Surgery for further recovery.