jdibble
True Blue
I am hoping someone who understands spine procedures can help with coding this surgery. Surgeon did Laminectomies with partial facetectomies and foraminotomies with evacuation of an epidural abscess at T10, L1 and L2, then C7-T9 laminotomies with evacuation of epidural abscess, plus T11-T12 excisional debridement of superficial, subfascial and bony elements. He wants to use codes 63046, 63048, 63020, 63035 and 22015. This physician's coder is thinking it should be coded 63265 as the only code. The physician does not feel that this represents the amount of work he did. This one is new for me so I am not sure the correct way to code this. Any suggestions on how this would be correctly coded would be greatly appreciated! Thanks!!
PROCEDURE PERFORMED:
1. T10, L1, and L2 laminectomies including partial facetectomies and foraminotomies.with evacuation of epidural abscess/phlegmon evacuation
2. C7, T1, T2, T3, T4, T5, T6, T8, T8, and T9 laminotomies with evacuation of epidural abscess/phlegmon evacuation.
3. Thoracic wound T11-T12 irrigation and excisional debridement of superficial, subfascial, and bony elements.
2. Utilization of intraoperative fluoroscopy for determination of levels.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. General endotracheal anesthesia was induced without complication. IV antibiotics were administered prior to incision. A time-out was commenced prior surgery to confirm appropriate levels. The patient was placed prone on the Jackson frame. All bony prominences well padded. The patient's eyes remained pressure free during the entirety of the case. The patient's back was prepped and draped in the usual sterile fashion.
A midline incision was made with a 10 blade scalpel from the C7 to L2 levels ellipsing out the previous thoracic scar at T11-12. Brisk bleeding was controlled with Bovie cautery. Sharp dissection was carried down through the fascia with subperiosteal elevation of the paraspinal muscles over the C7 through L2 spinous processes and lamina. The pars interarticularis was identified bilaterally. Caution was used to preserve the integrity of the facet capsules as the dissection was carried out laterally.
Minimal superficial purulence was noted at the T11-12 levels.
The superficial and deep thoracic wound was flushed and irrigated, followed by excisional debridement of necrotic subcutaneous, fascial, muscle and bone tissue. Sterile saline was flushed through the wound superficially and deep. The infected wound was 9 cm in length, 3 cm in width and 4 cm in depth.
Next, laminectomies were commenced with removal of the L1, L2, and T10 spinous process with a Leksell rongeur. The lamina was thinned further with this instrument. A high speed bur was also utilized to remove laminar bone and define the borders of the decompression. Next, Kerrisons #2, #3 and #4 were utilized to complete the laminectomies. The ligamentum flavum was resected from the underlying dural membrane as it was protected with a Penfield #3. The traversing L3, L2, and T11 nerve roots were directly visualized and decompressed. The lateral recess neural structures were protected with a Penfield #3 as a Kerrison #3 and Kerrison #4 rongeur were utilized in the lateral recesses. In addition, undercutting technique into the foramen was carried out bilaterally at L2-3, L1-2, and T10-11 to directly decompress the L2, L1, and T10 nerve roots. Epidural phlegmon was gently teased off the dural membrane and placed in a sterile specimen cup for pathology. An angiocath was placed ventral to the dural membrane and sterile saline was flushed in the ventral and dorsal epidural spaces from T10 through L2. Minimal purulence was noted.
Next, midline laminotomies were performed with Kerrison #2 and #3 at C7, T1, T2, T3, T4, T5, T6, T8, T8, and T9. The ligamentum flavum was resected midline at each interval exposing the dural membrane. No dorsal purulence was noted. An angio-cath was utilized level by level to flush sterile saline in the epidural space. Scattered dorsal epidural phlegmon was encountered at each level and resected with a Kerrison #2 from the C7 to T9 levels and removed through the laminotomy sites. Epidural culture swabs were taken at 2 separate midthoracic levels and sent to Microbiology.
After decompression, a blunt nerve probe passed easily into these recesses without resistance. The extent of the decompression was confirmed with a lateral fluoroscopic images. The wound was copiously irrigated with sterile saline under pulse lavage.
PROCEDURE PERFORMED:
1. T10, L1, and L2 laminectomies including partial facetectomies and foraminotomies.with evacuation of epidural abscess/phlegmon evacuation
2. C7, T1, T2, T3, T4, T5, T6, T8, T8, and T9 laminotomies with evacuation of epidural abscess/phlegmon evacuation.
3. Thoracic wound T11-T12 irrigation and excisional debridement of superficial, subfascial, and bony elements.
2. Utilization of intraoperative fluoroscopy for determination of levels.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. General endotracheal anesthesia was induced without complication. IV antibiotics were administered prior to incision. A time-out was commenced prior surgery to confirm appropriate levels. The patient was placed prone on the Jackson frame. All bony prominences well padded. The patient's eyes remained pressure free during the entirety of the case. The patient's back was prepped and draped in the usual sterile fashion.
A midline incision was made with a 10 blade scalpel from the C7 to L2 levels ellipsing out the previous thoracic scar at T11-12. Brisk bleeding was controlled with Bovie cautery. Sharp dissection was carried down through the fascia with subperiosteal elevation of the paraspinal muscles over the C7 through L2 spinous processes and lamina. The pars interarticularis was identified bilaterally. Caution was used to preserve the integrity of the facet capsules as the dissection was carried out laterally.
Minimal superficial purulence was noted at the T11-12 levels.
The superficial and deep thoracic wound was flushed and irrigated, followed by excisional debridement of necrotic subcutaneous, fascial, muscle and bone tissue. Sterile saline was flushed through the wound superficially and deep. The infected wound was 9 cm in length, 3 cm in width and 4 cm in depth.
Next, laminectomies were commenced with removal of the L1, L2, and T10 spinous process with a Leksell rongeur. The lamina was thinned further with this instrument. A high speed bur was also utilized to remove laminar bone and define the borders of the decompression. Next, Kerrisons #2, #3 and #4 were utilized to complete the laminectomies. The ligamentum flavum was resected from the underlying dural membrane as it was protected with a Penfield #3. The traversing L3, L2, and T11 nerve roots were directly visualized and decompressed. The lateral recess neural structures were protected with a Penfield #3 as a Kerrison #3 and Kerrison #4 rongeur were utilized in the lateral recesses. In addition, undercutting technique into the foramen was carried out bilaterally at L2-3, L1-2, and T10-11 to directly decompress the L2, L1, and T10 nerve roots. Epidural phlegmon was gently teased off the dural membrane and placed in a sterile specimen cup for pathology. An angiocath was placed ventral to the dural membrane and sterile saline was flushed in the ventral and dorsal epidural spaces from T10 through L2. Minimal purulence was noted.
Next, midline laminotomies were performed with Kerrison #2 and #3 at C7, T1, T2, T3, T4, T5, T6, T8, T8, and T9. The ligamentum flavum was resected midline at each interval exposing the dural membrane. No dorsal purulence was noted. An angio-cath was utilized level by level to flush sterile saline in the epidural space. Scattered dorsal epidural phlegmon was encountered at each level and resected with a Kerrison #2 from the C7 to T9 levels and removed through the laminotomy sites. Epidural culture swabs were taken at 2 separate midthoracic levels and sent to Microbiology.
After decompression, a blunt nerve probe passed easily into these recesses without resistance. The extent of the decompression was confirmed with a lateral fluoroscopic images. The wound was copiously irrigated with sterile saline under pulse lavage.