Question regarding Case #7 answers
Case#7 answer(s) - CPT 22514, 733.13
ICD-9-CM
733.13 Pathologic fracture of vertebrae
ICD-10-CM
M48.56xA Collapsed vertebra, lumbar region, NEC, initial encounter for closed fracture
Hint: Case# 7 Vertebral compression fracture is the preoperative diagnosis so you’ll need your to know your modifiers and a very good look up tool for this one!
Case# 7
PREOPERATIVE DIAGNOSIS: Painful L2 vertebral compression fracture.
POSTOPERATIVE DIAGNOSIS: Painful L2 vertebral compression fracture.
NAME OF OPERATION: L2 kyphoplasty.
FINDINGS PREOPERATIVELY:
She had compression fractures at T 11 and L1, which underwent kyphoplasty and she initially had very good results, but then developed back pain once again. Repeat MRI a couple of weeks later showed that she had fresh high intensity signal changes in the body of L2 and some scalping of the superior end plate consistent with a compression fracture at L2. After some preoperative discussion and some evaluation to see if she would get better, she was admitted to the hospital for L2 kyphoplasty when she was not getting better.
At surgery, L2 had some scalping of the superior end plate. Most of the softness was in the back part of the vertebral body.
PROCEDURE :
The patient was taken to the operating room and placed under general endotracheal anesthesia in a supine position. She was placed prone on the Jackson table and her back was prepped and draped in the usual sterile fashion. Timing biplane image intensifiers, the skin incision sites were marked out. 0.5k Marcaine with epinephrine was injected. Initially on the left side, a Xyphon trocar was passed down to the superior lateral edge of the pedicle and then passed down through the pedicle and into the vertebral body -uneventfully in the usual fashion. The drill was then placed into the vertebral body and then the Kyphon balloon tamp. In a similar fashion, the same thing was done on the other side. Balloons were then inflated uneventfully. The balloons were then deflated and removed and the cement when it was in the doughy state was then injected into the 2 sides in the usual fashion. This was done carefully and sequentially to make sure that there was no cement extrusions and in fact there were none, There was a good fill to the edges of vertebral body up towards the superior end plate and across the midline. The 'bone filling devices were then removed and the trocars removed, Pressure was applied after which the skin was sutured with 4-0 nylon. Sand-Aids were applied and she was taken to recovery in stable condition.
COMPLICATIONS :
There were no complications. ESTIMATED BLOOD LOSS: Minimal blood loss.
COUNTS:
Sponge and needle counts were correct.
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