betsycpcp
Networker
I work for a payer and we denied some of the billed procedures because I couldn't get enough information from the op report to be sure if the codes were correct. They have requested payment for the denied codes and sent the same op report as before, which has multiple blanks where the transcriptionist apparently couldn't understand what was said. I'm hoping someone with more knowledge of spine surgery can figure some of this out:
Diagnosis: L3 burst fracture with instability
Procedure:
1. Extracavitary lateral approach for complete diskectomy at L2-3, L3-4 with complete corpectomy, L3; partial vertebrectomy, L2; with interbody fusion using titanium _____ 2 cage with anterior and lateral plating traverse plate; harvest of bone with bone marrow aspirate as well as resection of rib for structural purposes and local bone source.
2. Posterior approach for transpedicular facet fixation Precep system, L2-L4; biplanar fluoro; intraoperative magnification microscope. Continuous neural monitoring greater than 3 hours.
Description: The patient was placed in the lateral decubitus position. Lateral incision was made. Retroperitoneal dissection was carried out. Transdermal stylet was placed. En bloc diskectomy was then carried out at the L3-4 region with continuous neural monitor and biplanar fluoro. Contralateral annulotomy was also performed. A similar procedure was done at the L2-3 region. Then a thrid pass was made through the psoas, again with continuous neural monitoring and biplanar fluoro and docked at the posterior mid body of L3. The table retraction was then docked. This then allowed for more dissection of the muscles of the lateral ___________. Osteotomes were then used to remove the vertebral body at the fracture site. Because the lateral portion of the L2 body had to be resected as well to allow for a complete coronal reduction. This was all done under the microscope. Then after endplates were completely prepared the ______ 2 was engineered on the back bench. ________ was placed. This was then packed with TCP and bone marrow aspirate which had been processed for stem cells and impacted in the space as well as local bone source from the rib which had been harvested through a separate fascial incision. In doing this the patient's kyphotic deformity was corrected. _______ screw was placed, more bone was placed around the cage. Bicoronal bolts were placed on either side of the corpectomy. They were secured in the usual _______ and torqued ______ 40 pounds to the transverse plate. Two lag screws were placed as well. Retractors were removed. The wound was closed in the usual fashion.
Then pedicle screw fixation was achieved at L2 and L4. Pedicles were sounded as well as continuous neural monitors throughout the case. These were secured in the usual fashion ______ a small _______ was done to allow for placement of the _______ lateral facet regions. Copious amounts of irrigation were instilled into the wound. The wound was closed in the usual sterile fashion.
They billed with 63102, 69990, 22533-51, 22534, 22845, 22851, 20936, 38220-59, 22633-51, 22634, 22842. We put on the EOB that we couldn't verify some of the codes due to blanks in the op report, but we haven't received a corrected one.
Please let me know if you agree with their codes, especially the fusion codes- 22533, 22534, 22633, 22634.
Thanks!
Diagnosis: L3 burst fracture with instability
Procedure:
1. Extracavitary lateral approach for complete diskectomy at L2-3, L3-4 with complete corpectomy, L3; partial vertebrectomy, L2; with interbody fusion using titanium _____ 2 cage with anterior and lateral plating traverse plate; harvest of bone with bone marrow aspirate as well as resection of rib for structural purposes and local bone source.
2. Posterior approach for transpedicular facet fixation Precep system, L2-L4; biplanar fluoro; intraoperative magnification microscope. Continuous neural monitoring greater than 3 hours.
Description: The patient was placed in the lateral decubitus position. Lateral incision was made. Retroperitoneal dissection was carried out. Transdermal stylet was placed. En bloc diskectomy was then carried out at the L3-4 region with continuous neural monitor and biplanar fluoro. Contralateral annulotomy was also performed. A similar procedure was done at the L2-3 region. Then a thrid pass was made through the psoas, again with continuous neural monitoring and biplanar fluoro and docked at the posterior mid body of L3. The table retraction was then docked. This then allowed for more dissection of the muscles of the lateral ___________. Osteotomes were then used to remove the vertebral body at the fracture site. Because the lateral portion of the L2 body had to be resected as well to allow for a complete coronal reduction. This was all done under the microscope. Then after endplates were completely prepared the ______ 2 was engineered on the back bench. ________ was placed. This was then packed with TCP and bone marrow aspirate which had been processed for stem cells and impacted in the space as well as local bone source from the rib which had been harvested through a separate fascial incision. In doing this the patient's kyphotic deformity was corrected. _______ screw was placed, more bone was placed around the cage. Bicoronal bolts were placed on either side of the corpectomy. They were secured in the usual _______ and torqued ______ 40 pounds to the transverse plate. Two lag screws were placed as well. Retractors were removed. The wound was closed in the usual fashion.
Then pedicle screw fixation was achieved at L2 and L4. Pedicles were sounded as well as continuous neural monitors throughout the case. These were secured in the usual fashion ______ a small _______ was done to allow for placement of the _______ lateral facet regions. Copious amounts of irrigation were instilled into the wound. The wound was closed in the usual sterile fashion.
They billed with 63102, 69990, 22533-51, 22534, 22845, 22851, 20936, 38220-59, 22633-51, 22634, 22842. We put on the EOB that we couldn't verify some of the codes due to blanks in the op report, but we haven't received a corrected one.
Please let me know if you agree with their codes, especially the fusion codes- 22533, 22534, 22633, 22634.
Thanks!