Wiki Laminectomy and instrumentation question

[icys@aol.com]

Pre op dx: L4 burst fracture
procedures performed:
1. Bilateral l3 and l5 pedicle screw instrumentation using invasive instrumentation.
2. Posterolateral fusion of l3-l5
3.use of autograft
4.use of allograft
5.partial laminectomy of l3 and the upper portion of l4
6. Use of fluoroscopy

what codes do you advise please help.

Thanks

 

[sebastianaj]

22612
22614
22842
20936
63047

 

[penguins11]

There is not enough information to give an answer, Is the instrumentation segmental or nonsegmental, if segmental I would bill 22842, non segmental bill 22840.

For the allograft, if morselized its 20930, structural is 20931.

For the autograft, local bone is 20936 (pieces obtained through the same incision as the fusion, graft obtained through the hip is usually 20937.

Posterolateral fusion is probably 22612 and 22614.

The laminectomy is billed per nerve root decompressed, per foraminotomy if he documents foraminotomies at L3 and L4 you can bill 63047 and 63048. If the foraminotomy is not specified I would only bill 63047.

However, since you also stated that the person had a burst fracture I would look at codes 22325,22328 if he documents doing the lami and reducing the fracture. If he documents reducing the fracture you bill the codes per fractured vertebra or dislocated segment so It would probably be 22325.