Wiki Lumbar Endoscopic decompression

[kehinde]

Please i need your help in coding this Asap. I am so confused as to the right code for lumbar endoscopic decompression at L4-L5. and also for Minimal Invasive Lumber decompression (MILD). This is what i'm considering:

LED ---62287
MILD --63056 since code 0275t is been denied & regarded by most insurance as experimental.

Pre-op Diagnoses : Degeneration of lumbar spine at L4-l5 wth bilateral stenosis and radiculopathy affecting both lower extremities.

Post-Op diagnoses : Degeneration of lumbar spine at L4-l5 wth bilateral stenosis and radiculopathy affecting both lower extremities.

Procedure : Bilateral lumbar endoscopic decompression at L4-L5

Detail of procedure:

Under fluoroscopic control, the level of the last mobile segment which i have labelled L4-L5 disk was marked on the skin. Starting on the right side, portal site was selected 12cm to the right of midline. Stab incision was made and spinal needle was introduced through the portal and advanced until it abutted the hypertrophied superior articular process of the L4-L5. On routine, the shaving of the superior articular process of the L4-L5 .On routine, the shaving of the superior articular process was carried with reamers into the disk space. From that point , instrumentation with the dilator and cannula was carried out. The cannula was advanced and docked into the disk. ther was no nerve root irritation. At this point, the guidewire and the obturator were removed and a 5mm trephine was used to perform annulotomy. The cannula was then advanced and docked into the disk. From this point, grasping forceps were used to remove some disk material and athroscope was attached. Further diskectomy was carried out to expose epidural fat. Pulsating dura was identified. The exiting and the traversing nerve roots were identified and found to be free. Hence, procedure was concluded and repeated on the left side in a similar manner.

At the conclusion, there was no neural deficit. PRP was injected into both surgical site.


Thanks for your help.

 

[penguins11]

I would review the past coding edge magazines, they have a very good article about minimally invasive per endoscopic. And what and when to bill the new codes. Also, you cant bill an open procedure just because the insurance company is denying the new code. You should bill with what is correct coding not what the insurance company will pay. If the incorrect code wasnt authorized you may have to write this off. Also, I wouldnt use 63056 regardless, 63056 is for a far lateral disc. 63030 is for the posterior lumbar discectomy. You can use an assistive device and still bill 63030. MIS procedures are considered "open" when the anatomy being operated on can be seen with the naked eye through the incision. you can use a fluoroscope or endoscope but the procedure should be able to be performed without them. MIS proedure are considered percutaneous when the insicion is too small to see the anatomy and an assistive device has to be used to perform the operation, in which case 62287 or 0275T would be appropriate depending on what was done. Insuance companies may not pay for either code (62287 or 0275T), if you cant get an auth because its outpatient and auth isnt required, I would get a predetermination prior to the surgery or have the patient sign a notice saying that they are willing to pay and are aware the surgery isnt covered.