Kyphoplasty and bilateral pedicle screw fixation

tboback

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Severe T12 fracture corrected using Kyphoplasty and T11 to L1 pedicle screw fixation, bilateral. I coded 22513 and 22840. Auto insurance is denying. Any suggestions?

Any help would be appreciated.
Thank you,
Tina M Boback, CPC
 

TBAUSLEY

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Hello Tina,
Can you add the complete note? maybe I can assist with your denial.

TawanaB.
 

tboback

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Op Note

Here is the op note, thank you!

PROCEDURES:
1. Thoracic 12 kyphoplasty.
2. Thoracic 11 to lumbar 1 pedicle screw fixation, bilateral.
3. Biplanar C-arm fluoroscopic guidance.

PREOPERATIVE DIAGNOSES:
1. Thoracic 12 burst fracture.
2. Intractable back pain.

POSTOPERATIVE DIAGNOSES:
1. Thoracic 12 burst fracture.
2. Intractable back pain.

ESTIMATED BLOOD LOSS: 20 mL.

NDICATIONS: The patient was evaluated secondary to intractable low back pain after being
involved in a motor vehicle accident. Given the symptomology, the patient
had radiological imaging, this revealed a thoracic 12 burst fracture with
fragmentation noted anteriorly without any significant retropulsion. The
patient is having intractable pain. MRI was completed to rule out any
further ligamentous injury. Given the acuity in nature and the burst
fracture as well as intractable pain after all risks and benefits were
discussed as well as multiple surgical as well as nonsurgical options, the
patient was agreeable to proceed with thoracic 12 percutaneous kyphoplasty
as well as percutaneous placement of pedicle screws at thoracic 11 and
lumbar 1 bilaterally. All risks and benefits were discussed, she was
agreeable and elected to undergo intervention.

DESCRIPTION OF PROCEDURE: The patient was brought to the operative suite
where they was placed under general anesthesia after endotracheal
intubation in prone position with all pressure points being padded
appropriately. Then, utilizing biplanar C-arm fluoroscopic guidance, the
incision site was approximated and marked. The patient was prepped and
draped in the usual fashion. Timeout was completed, antibiotics
administered and the skin was infiltrated with 0.25% Marcaine with
epinephrine at all anticipated sites, in addition neuro monitoring was
utilized throughout the whole case, which was stable throughout the whole
case. At this point, a stab incision was made on the right side.
Utilizing a beveled trocar needle, the vertebral body was cannulated at
thoracic 12 beginning at the lateral aspect of the pedicle, aiming for the
medial pedicular wall at the posterior vertebral wall line. Once
cannulated, the inner stylet was withdrawn and a drill was utilized to
drill to the contralateral side. At this point, a balloon was inserted,
inflated, deflated and removed and at this point, the methylmethacrylate
was injected. Once this was done, inner stylet was withdrawn. Pressure
was held at the skin site. The skin was approximated with #3 RB1 suture
in inverted subcuticular fashion, completing the portion of thoracic 12
kyphoplasty at this level. Next, 4 small incisions were made at
approximately thoracic 11 and lumbar 1 bilaterally. Utilizing
electrocautery Bovie, dissection was carried down to the fascia. At this
point, a beveled trocar needle was utilized first to cannulate thoracic 11
on the right side, beginning at the lateral aspect of the pedicle, aiming
for the medial pedicular wall at the posterior vertebral wall line. The
inner stylet was withdrawn. A guidewire was advanced into the vertebral
body. Next, the same was done on lumbar 1 on the right side. Utilizing a
beveled trocar needle, the vertebral body was cannulated beginning at the
lateral aspect of the pedicle, aiming for the medial pedicular wall. At
the posterior vertebral wall line, the inner stylet was withdrawn and the
guidewire was advanced into the vertebral body, and then on the left side
on thoracic 11, utilizing a beveled trocar needle, the vertebral body was
cannulated beginning at the lateral aspect of the pedicle, aiming for the
medial pedicular wall of the posterior vertebral wall line, the inner
stylet was withdrawn. A guidewire was then advanced and then at lumbar 1,
utilizing a beveled trocar needle, the vertebral body was cannulated
beginning at the lateral aspect of the pedicle, aiming for the medial
pedicular wall at the posterior vertebral wall line. Once all 4
guidewires were placed and at that point, the pedicle screws were
advanced, 5.5 x 50 mm screws were advanced at thoracic 1 and lumbar 1
bilaterally. Once advanced, these were tested with neuromonitoring and
found to be within acceptable values. Next, a 90-mm rod was then placed
between the tulips bilaterally. Set cap screws were advanced and counter
torqued into position and secured. The towers were removed. The
incisions were irrigated with antibiotic solution. The fascia was closed
with 2-0 Vicryl suture. The muscle was injected with a cocktail narcotic
solution. Dead space was closed with 2-0 Vicryl suture and 3-0 RB1
suture. A Steri-Strip, Mastisol cast was made. All counts were correct.
The patient tolerated the procedure well and will be observed overnight.
 

TBAUSLEY

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Hello Tina,
I suggest an unlisted CPT Pedicle fixture instrumentation 28999 you will need to send operative report.
The instrumentation is being denial, due to no primary CPT to use 22840 (page125)

Your CPT 22513 for Kyphoplasty procedures includes image guidance.


Hopefully this will help you.
TawanaB,CPC
 
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