Question L5-S1 minimally invasive foraminotomy

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I am newer to Neurosurgery and my doctor is questioning my coding for this op note: dx is

Left L5-S1 foraminal stenosis


PROCEDURE: After proper identification, the patient was taken to the operating room and placed under general anesthesia. All appropriate lines were placed by anesthesia team. He was positioned prone on a Wilson frame with all pressure points padded. He received prophylactic antibiotics prior to skin incision.

The lumbar area was prepped and draped in sterile fashion. A spinal needle was then inserted at the left L5-S1 facet and fluoroscopy used to confirm the appropriate level of surgery. Through this needle, local anesthetic was injected at the facet as well as along the tracts towards the skin. After skin incision, electrocautery was used for subcutaneous hemostasis. A K-wire was then inserted through the lumbosacral fascia to the left L5-S1 facet. Fluoroscopy confirmed appropriate placement of the wire. Over the wire METRx dilators were placed and then an 18 mm tube positioned.


At this point, the microscope was brought into the field. Fluoroscopy showed good placement of the METRx tube. The left hemi-laminae of L-5 as well as the pars interaticularis were cleaned of any overlying soft tissue with cautery. High-speed drill was then used to perform a foraminotomy at the junction of the lateral pars interaticularis and superior facet. The ligamentum flavum was then elevated and removed in piecemeal fashion to expose the exiting L5 nerve root. At the end there was good decompression and the nerve root appeared free. FloSeal was applied for hemostasis and copious wound irrigation performed. DepoMedrol was injected into the epidural space surrounding the nerve root. Local anesthetic was injected into the skin and muscle. The incision was closed in layered fashion with Prineo on the skin.  All counts were correct. Sterile dressing was applied. The patient was extubated and transported to recovery in stable condition.

I thought it should be 63047.

Any help would be appreciated
 

thomas7331

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This specialty isn't my strong point, but as I understand it, 63047 would be the code for an open approach. For the minimally invasive procedure, I believe that the correct code would be 0275T.
 

fwnewbie

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0275T describes a percutaneous endoscopic approach the work being done by indirect visualization but he used a microscope for the decompression I've only studied facility but don't you need a code for microscope? 69990
I had to google what a MedRx was because I was thinking arthrodesis, but it's a nifty little tool to get you in where you want to go with less tissue damage.
 
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I was asked if the Floseal can be billed separately for some kind of reimbursement. It adds an additional cost to our case but sometimes it is not actually used. I have not found anywhere that states you can bill extra for it. Thank you in advance for any help.
 

fwnewbie

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I was asked if the Floseal can be billed separately for some kind of reimbursement. It adds an additional cost to our case but sometimes it is not actually used. I have not found anywhere that states you can bill extra for it. Thank you in advance for any help.
I used to work for plastic surgeons and we had to specifically mix the Floseal components only if/when the MD decided it was needed for that case. If your procedure for Floseal use is similar, the components are restockable for another case when not used to keep expenses down.
 
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