Was hoping someone could help with the coding for the following procedure. Dr. states it is a partial facetectomy but he also burts a facet cyst as well. Any insight is appreciated!
THE PATIENT WAS TAKEN TO THE OPERATING ROOM AND PLACED IN THE PRONE POSITION. THE LUMBAR AREA WAS PREPPED IN A STERILE FASHION. USING FLUOROSCOPIC GUIDANCE, THE L4-5 FACET WAS IDENTIFIED. THE SKIN WAS INFILTRATED WITH 1% XYLOCAINE. USING 2 SEPARATE 18 GUAGE 3.5 INCH SPINAL NEEDLES THE L4-5 FACET WAS ENTERED FROM A LEFT OBLIQUE ANGLE AND ALSO FROM AN INFEROMEDIAL TO LATERAL ANGLE CREATING TWO PORTS. THEN 2 ML OF CONTRAST WAS INJECTED TO PRODUCE INTRAOPERATIVE FACET ARTHROGRAM. GOOD FLOW WAS SEEN INTO THE FACET CYST. IT WAS THEN RUPTURED USING PRESSURE TO OVERFILL THE CYST. AT THIS POINT, THE SKIN WAS INFILTRATED WITH 1% XYLOCAINE AGAIN, AND THEN A #11 BLADE WAS USED TO INCISE THE SKIN, THE EPIDERMIS, AND DERMIS USING BOVIE CAUTERY WITH ABLATED INSULATED EXTENDED TIP.
THIS WAS INSERTED THROUGH THE LANCED INCISION DOWN TO THE LEFT L4-5 FACET. PLACEMENT WAS CONFIRMED ON AP AND LATERAL FLUOROSCOPIC IMAGING. AT THIS POINT, BOVIE CAUTERY WAS USED TO CUT THE DORSOLATERAL ASPECT OF THE L4-5 FACET OUT. IRRIGATION WAS USED FROM ONE 18 GUAGE NEEDLE FLOWING THROUGH THE FACET JOINT AND OUT THE OTHER 18 GUAGE NEEDLE. DEBRIS FROM PARTIAL EXCISION OF THE FACET CAPSULE WAS SEEN COMING OUT OF THE SECOND 18 GUAGE NEEDLE. SALINE WITH BACITRACIN WAS USED TO FLUSH OUT DEBRIS AS WELL AS FOR ANTIBIOTIC PURPOSES. AT THIS POINT, 40 MG OF TRIAMCINOLONE AND 1ML OF 0.25% MARCAINE WAS INJECTED. THE PATIENT TOLERATED THE PROCEDURE WELL.......
THE PATIENT WAS TAKEN TO THE OPERATING ROOM AND PLACED IN THE PRONE POSITION. THE LUMBAR AREA WAS PREPPED IN A STERILE FASHION. USING FLUOROSCOPIC GUIDANCE, THE L4-5 FACET WAS IDENTIFIED. THE SKIN WAS INFILTRATED WITH 1% XYLOCAINE. USING 2 SEPARATE 18 GUAGE 3.5 INCH SPINAL NEEDLES THE L4-5 FACET WAS ENTERED FROM A LEFT OBLIQUE ANGLE AND ALSO FROM AN INFEROMEDIAL TO LATERAL ANGLE CREATING TWO PORTS. THEN 2 ML OF CONTRAST WAS INJECTED TO PRODUCE INTRAOPERATIVE FACET ARTHROGRAM. GOOD FLOW WAS SEEN INTO THE FACET CYST. IT WAS THEN RUPTURED USING PRESSURE TO OVERFILL THE CYST. AT THIS POINT, THE SKIN WAS INFILTRATED WITH 1% XYLOCAINE AGAIN, AND THEN A #11 BLADE WAS USED TO INCISE THE SKIN, THE EPIDERMIS, AND DERMIS USING BOVIE CAUTERY WITH ABLATED INSULATED EXTENDED TIP.
THIS WAS INSERTED THROUGH THE LANCED INCISION DOWN TO THE LEFT L4-5 FACET. PLACEMENT WAS CONFIRMED ON AP AND LATERAL FLUOROSCOPIC IMAGING. AT THIS POINT, BOVIE CAUTERY WAS USED TO CUT THE DORSOLATERAL ASPECT OF THE L4-5 FACET OUT. IRRIGATION WAS USED FROM ONE 18 GUAGE NEEDLE FLOWING THROUGH THE FACET JOINT AND OUT THE OTHER 18 GUAGE NEEDLE. DEBRIS FROM PARTIAL EXCISION OF THE FACET CAPSULE WAS SEEN COMING OUT OF THE SECOND 18 GUAGE NEEDLE. SALINE WITH BACITRACIN WAS USED TO FLUSH OUT DEBRIS AS WELL AS FOR ANTIBIOTIC PURPOSES. AT THIS POINT, 40 MG OF TRIAMCINOLONE AND 1ML OF 0.25% MARCAINE WAS INJECTED. THE PATIENT TOLERATED THE PROCEDURE WELL.......