jdibble
True Blue
Can anyone help with how to code this? Patient had a L5-S1 fusion 10 days before but then developed a fracture probably due to osteoporosis. He did an exploration of the previous fusion and found everything to be good. He then did the procedure below: I found 22848 for pelvic fixation, however that is an add-on code. I am not sure what could be a primary code! Can someone help with what other codes can be billed?
Navigation
I placed for maxillofacial marker screws and or the appropriate fiducial. We then did an O arm spin. We used the fiducial markers to facilitate registration of the navigation and then navigated Thoracic the case. We frequently checked each tool against the screws for point-to-point registration confirmation.
A landmark an appropriate trajectory for S2 AI screws. I used the teardrop approach to appropriately stay within bone. I burred an entry point and then used the drill or awl to broach into the cancellous bone of the pelvis. This went through the sacral ala at S2 and into the ilium crossing the SI joint. I used a probe to ensure that we are well within bone at the endpoint. I then tapped an undersized tapped and selected a screw to place on each side which was a 8.5 x 80 mm. I assessed whether I need to remove and he the previous pedicle screws and upsized.
The screws were stimulated with a neuromonitoring probe. All pedicle screws stimulated above acceptable threshold levels. The left S2 AI stimulated above 20, the right S2 AI stimulated above 20, .
Instrumentation and fixation
At this point, rods were contoured into lumbar lordosis and placed into the tulips of the pedicle screws from L5 to the S2AI screws bilaterally. The end caps were tightened to the appropriate end-torque values. The cephalad vertebra was reduced to the rod via the Tulip screws and then compressed to caudal vertebra before final tightening. All hardware was tightened to a final torque. Were then placed a crosslink between S1 and the pelvic screws due to the S1 fracture to avoid lateral shear and torsional instability
Thanks for all help!
Jodi
Navigation
I placed for maxillofacial marker screws and or the appropriate fiducial. We then did an O arm spin. We used the fiducial markers to facilitate registration of the navigation and then navigated Thoracic the case. We frequently checked each tool against the screws for point-to-point registration confirmation.
A landmark an appropriate trajectory for S2 AI screws. I used the teardrop approach to appropriately stay within bone. I burred an entry point and then used the drill or awl to broach into the cancellous bone of the pelvis. This went through the sacral ala at S2 and into the ilium crossing the SI joint. I used a probe to ensure that we are well within bone at the endpoint. I then tapped an undersized tapped and selected a screw to place on each side which was a 8.5 x 80 mm. I assessed whether I need to remove and he the previous pedicle screws and upsized.
The screws were stimulated with a neuromonitoring probe. All pedicle screws stimulated above acceptable threshold levels. The left S2 AI stimulated above 20, the right S2 AI stimulated above 20, .
Instrumentation and fixation
At this point, rods were contoured into lumbar lordosis and placed into the tulips of the pedicle screws from L5 to the S2AI screws bilaterally. The end caps were tightened to the appropriate end-torque values. The cephalad vertebra was reduced to the rod via the Tulip screws and then compressed to caudal vertebra before final tightening. All hardware was tightened to a final torque. Were then placed a crosslink between S1 and the pelvic screws due to the S1 fracture to avoid lateral shear and torsional instability
Thanks for all help!
Jodi
