Question Instrumentation Only

JenReyn99

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Need help to figure out what CPT's I should use here, haven't seen this technique before, and don't generally see instrumentation alone. The pt. had previous anterior fusion done prior, but was playing with kids and had an issue. This was done posterior. Any help is greatly appreciated!!

"...the Jamshidi needles were introduced with navigation after a post was placed in the iliac bone and the localization unit of the Stealth system was then placed. The o-arm was brought into the field and the intraoperative CT scan was obtained, the image was accepted for accuracy and the the rest of this part of the operation was performedunder navigation with the Stealth navigation system. So, again the Jamshidi needle navigated was introduced through the incision on one side in the right side and then advanced to the junction of the transverse process with the upper facet of L4 and then with gentle tapping with a hammer, the Jamshidi needle was introduced through the cortex of the bone and advanced through the pedicle into the vertebral body into the posterior third and then after this, a K-wire was advanced to ___ anchor in the anterior aspect of the bone of the vertebral body of L4. The Jamshidi needle was then withdrawn and the same procedure was performed in the contralateral side and both sides of L5 and S1 until the K-wires were all in place. After these, using the K-wires as a guide and still with navigation, the tapping device was used to tap all the perforations and the 50 mm polyaxial 6 mm diameter screws were then put in place using the K-wires as a guide and with navigated tools to facilitate the placement of the screws. In this manner, bilateral pedicle screws were put in place at L4, L5, and S1. The K-wires were removed and the pedicle screws were attached to the percutaneous towers, using these towers, then the measuring device were put in place between the upper and lower tower for measurement for the rod. The rod was opened from its sterile packaging, introduced with the special introducer through the windows of the tower and placed between the tulips of the polyaxial heads of the screws in each side to span from L4 to S1 and then locking screws were put in place to attach and secure the connections of the rod to the towers. All connections were tightened to company's specifications. The towers were removed and then the incisions were closed. The aponeurosis was closed....."
 

amyjph

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So they were kind of shoring up the anterior fusion by placing posterior instrumentation? Was it loose? Interesting, I don't know in all my years of spine that I ever saw this. There was nothing else done in the case?
I want to say 22849 but that's not it. I think you might have to do unlisted with a comparison to the insert posterior instrumentation or maybe 22849. It's an oddball. Have you found any coding clinic or CPT Asst at all?
 

JenReyn99

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Basically, yes, they were just reinforcing the anterior fusion. This is the entire report. I was thinking 22849 as well, but then that doesn't quite fit. I haven't ever seen this scenario either, and I've been doing neuro for a number of years. So I was also thinking unlisted, but then the likelihood of payment is quite low, so I was just trying to come up with SOMETHING. This is a head scratcher for sure. I haven't found any resources.
 

amyjph

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Basically, yes, they were just reinforcing the anterior fusion. This is the entire report. I was thinking 22849 as well, but then that doesn't quite fit. I haven't ever seen this scenario either, and I've been doing neuro for a number of years. So I was also thinking unlisted, but then the likelihood of payment is quite low, so I was just trying to come up with SOMETHING. This is a head scratcher for sure. I haven't found any resources.
I don't think there is any other route to go but unlisted.
 
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