WENDYT
New
I need some help with coding this case we coded it with 20999 and got a denial from the payer. The excerpt is below, any help will be greatly appreciated.
With the use of lateral fluoroscopy the safe zone for placement of a screw into S1 was marked onto the skin. A small oblique
incision was made at this point. This is bluntly dissected down onto the bone. A pig sticker apparatus was advanced down the
lateral aspect of the pelvis. With the use of multiple views of fluoroscopy including inlet and outlet views the start point and entry
trajectory were adjusted until an appropriate trajectory was found that would allow a screw to be passed entirely across the
sacrum and include purchase in both of the ileum. An entry guidewire was then passed through this across both iliac bones as
well as the sacrum. Its position was confirmed on multiple views of fluoroscopy. A second guidewire was placed in a similar
fashion also into S1. Of note imaging demonstrated a very large S1 body with a relatively small rest of the sacrum.
Measurement was taken off of both of these guidewires. A 7.3 mm partially threaded cancellus cannulated titanium screw with a
washer was first placed. This failed to get significant purchase. Over the second guidewire a second Synthes 7.3 mm titanium
cannulated cancellus screw was placed. The screw got excellent purchase. The first screw that was placed was attempted to be
removed and was replaced with a slightly longer 6.5 millimeter screw. Once again no significant purchase was obtained.
Therefore the screw and washer were removed.
With the use of lateral fluoroscopy the safe zone for placement of a screw into S1 was marked onto the skin. A small oblique
incision was made at this point. This is bluntly dissected down onto the bone. A pig sticker apparatus was advanced down the
lateral aspect of the pelvis. With the use of multiple views of fluoroscopy including inlet and outlet views the start point and entry
trajectory were adjusted until an appropriate trajectory was found that would allow a screw to be passed entirely across the
sacrum and include purchase in both of the ileum. An entry guidewire was then passed through this across both iliac bones as
well as the sacrum. Its position was confirmed on multiple views of fluoroscopy. A second guidewire was placed in a similar
fashion also into S1. Of note imaging demonstrated a very large S1 body with a relatively small rest of the sacrum.
Measurement was taken off of both of these guidewires. A 7.3 mm partially threaded cancellus cannulated titanium screw with a
washer was first placed. This failed to get significant purchase. Over the second guidewire a second Synthes 7.3 mm titanium
cannulated cancellus screw was placed. The screw got excellent purchase. The first screw that was placed was attempted to be
removed and was replaced with a slightly longer 6.5 millimeter screw. Once again no significant purchase was obtained.
Therefore the screw and washer were removed.