Kypho with Facet block?????

tboback

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Can Kyphoplasty and Facet block be billed together? CCI edits say they can, but I wanted to see if anyone had this come up before.

Op note incase anyone is interested...
PROCEDURES:
1. Balloon reduction of compression fracture at T11.
2. Vertebroplasty at T9.
3. Biplanar fluoroscopic guidance and interpretation.
4. T11 percutaneous kyphoplasty.
5. Facet block at the level of T11 on the right and T9 on the left;
unilateral approach on both T9 vertebroplasty and T11 kyphoplasty.

PREOPERATIVE DIAGNOSES:
1. Compression fracture of T9 and T11.
2. Intractable back pain, nonradicular.
3. Failure of conservative management.

POSTOPERATIVE DIAGNOSES:
1. Compression fracture of T9 and T11.
2. Intractable back pain, nonradicular.
3. Failure of conservative management.

SURGEON:

FIRST ASSISTANT:
ESTIMATED BLOOD LOSS: None.

FLUIDS: 500 mL of crystalloid.

SPECIMEN: None.

DRAINS: None.

COMPLICATIONS: None.

INDICATIONS: This is an XXXXX, who apparently fell
and had immediate back pain that was nonradicular. The patient has a
history of a T12 kyphoplasty. The MRI did demonstrate bone edema at the
level of T9 and T11. XXXXX was also tender to percussion at that level as
well. Risks and benefits were explained to the patient. The patient
elected to undergo kyphoplasty for reduction of pain.

PROCEDURE IN DETAIL: After informed consent was obtained, the patient was
brought into the operating suite where XXXXX identity was verified using XXXXX
name tag and cross-referencing with existing films and chart. The patient
was put under general anesthesia and intubated, was put in prone position
onto the flat top table with gel rolls. All areas were padded
appropriately. The level of T11 was then localized using biplanar
fluoroscopic guidance. The area was then prepped and draped in the usual
sterile fashion. The right pedicle of T11 was localized using biplanar
fluoroscopic guidance. A 0.25% Marcaine was used to anesthetize the skin.
A spinal needle was then used to localize the right pedicle at the level
of T11. We then performed a facet block at this level. Once we performed
our facet block at the right facet T11, the spinal needle was withdrawn
and a very tiny horizontal incision was made using 11 blade, and the
trocar was introduced into the patient. We used biplanar fluoroscopic
guidance to again localize the right pedicle of T11, and once this was
verified, we proceeded to hammer the trocar in, in an unilateral fashion,
and made sure that we did not breach the spinal canal. Once the trocar
was in place, we then drilled the vertebral body. The drill was then
withdrawn and a balloon was put in place. This was all verified using
biplanar fluoroscopic guidance. The balloon was inflated and the fracture
was then reduced. We then let the balloon in and we then localized using
a biplanar fluoroscopic guidance, the left pedicle of T9. We then
anesthetized the skin using 0.25% Marcaine. We then inserted a spinal
needle into the patient, and using biplanar fluoroscopic guidance, we
verified the level and found the pedicle and found the facet. We then
performed a facet block on the left at T9. The spinal needle was then
withdrawn and a horizontal incision was made using an 11 blade needle.
Then, a trocar was then introduced into the T9. Using biplanar
fluoroscopic guidance, we made sure that the spinal canal was not
penetrated. Once trocars were in place, we removed the inner stylet and
replaced it with a drill. We then drilled through the vertebral body and
it was felt to be somewhat hard and sclerotic. We withdrew the drill and
inserted the balloon. The balloon was not able to penetrate completely
through the vertebral body. The balloon was then withdrawn and
methyl methacrylate was used at the level of T9 and at the level of T11 as
well. Once adequate cement was used, we then waited for a few minutes
until the cement hardened. We verified on biplanar fluoroscopy that there
was no extravasation of the cement outside the vertebral body. We then
withdrew the inner stylet and the cement location was verified on biplanar
fluoroscopy, there was no cement in the tubes. We then withdrew the tubes
and verified again on biplanar fluoroscopy, there was no cement in the
pedicles. There was no significant hemorrhaging, and therefore,
hemostasis was already achieved. The skin was then cleaned and dried, and
Dermabond was used to close the incision. A dry dressing was used on top
of the skin. The patient tolerated the procedure well and was extubated
and sent to PACU in satisfactory condition.

COMPLICATIONS: None.

ESTIMATED BLOOD LOSS: 0.
 
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