Coding FX care w/Laminectomy


San Jose, CA
Best answers
Hi all - I can't get a reply from Neuro so I'm hoping Compliance can provide insight. CCI says if different incision but it isn't. Auditor says yes and management is saying to follow auditor.

Please advise:

I have been told by our outside auditors that I need to charge for the fracture care along with the laminectomy/fusion.

Is this correct?


1. L2 laminectomy.
2. T12-L4 percutaneous pedicle screw fixation with DePuy Synthes spine Viper Prime system.

who fell from a height onto his back while working at a house and sustained an L2 burst fracture. Fortunately, he was neurologically intact but had a tight canal at L2. He was offered the above surgery for decompression as well as stabilization of the unstable burst fracture.

PROCEDURE IN DETAIL: The patient was brought to the OR and was given general endotracheal intubation and anesthesia. He was then transferred to the operating table and placed in a prone position with all pressure points well buffered. The intraoperative CT Airo system was used. Neurophysiological electrodes were also placed before and after positioning and were found to be stable. The back was then prepared using Betadine and he was draped in a sterile fashion. Lidocaine 1% lidocaine and 1:200,000 epinephrine were then infiltrated along the planned incision line. A scout film was performed with a CT scan and the T8 spinous process was exposed and the BrainLAB reference arm was then clamped onto this spinous process. The patient then underwent a CT scan spanning the T10-L5 levels. Attention was then turned towards the L2 decompression, and a small incision over the L2 area was then performed in the midline. The paraspinal muscles were dissected and the spinous processes of L2 were entirely removed, as well as the inferior half of the L1 spinous process. The laminectomy was then performed and a good decompression was accomplished at that level. Hemostasis was achieved and the wound was irrigated with bacitracin saline.

Attention was then turned towards putting the percutaneous pedicle screws. Small stab wounds were made approximately 3 cm lateral to the midline as guided by the navigation system. The DePuy Synthes spine Viper Prime system was used throughout the procedure and the screws placed and confirmed having good placement using the intraoperative CT. Each screw was also stimulated and found to have a high amplitude of stimulation, all above 20. The stab wounds and the reference array was taken off and irrigated with bacitracin saline. The wounds were closed with 0 Vicryl to the deep fascial layer, 2-0 Vicryl to subcutaneous layer and staples applied to the skin. A Hemovac drain was placed in the laminectomy wound. Then, 0.5% Marcaine was
infiltrated along the wounds postoperatively