sacash
New
I am unsure of how to bill the following lumbar tumor excision. I keep going to 63277 but that does not seem correct. Any help is appreciated! TIA!!
Once the L3 was confirmed as well as the disk spaces above and below, 1st diskectomies were performed at the L2-3 and L3-4 levels. This was taken all the way back to the posterior aspect of the vertebral bodies. Curve curettes were used to get behind the vertebral body and complete diskectomies were performed back to the posterior longitudinal ligament. At this point, once this was on L2 and L3 all the way out to the edge of the vertebral bodies, the large Leksell rongeur was used to resect the entire vertebral body. Just a shell of the cortical bone was left on both sides to help with the fusion mass. A curved curette was placed behind the vertebral body, between the dura, epidural bleeders and the tumor. Curved curettes, and 3-0 and 4-0 Kerrisons were used to resect the tumor along the dura. The some shells of cortical bone were left on the dura. Those could not be easily peeled off or left in place. The right-sided L3 foramen was also cleared out. The L3 nerve root was identified and this was completely decompressed if any tumor to minimize
chance of persistent L3 radiculopathy which we had before. At this point, the endplates were prepared and the 22 mm end caps were used, 1st with 3 in 3 degrees at each end cap, but this did require more lordosis to an 8-degree, end cap was used and this showed good position on AP and lateral views. After the endplates were prepared down to bleeding bone, the Vlift was packed with Vitoss and iliac crest bone graft. This was put into place confirming to be good position in AP and lateral views. Next, the anterior plate was applied. A 65-mm anterior plate and 25-mm screws were placed 1st in the L4 and then in L2. We had difficulty getting the approach safely with retraction of the aorta into the superior right-sided L2, so we left this out. The locking device was employed to lock these screws into place. Final x-rays confirmed good position of the hardware. Next, wound was copiously irrigated. Vancomycin 500 mg sprinkled into the wound. Hemostasis was ensured and then the wound was closed in layers.
Once the L3 was confirmed as well as the disk spaces above and below, 1st diskectomies were performed at the L2-3 and L3-4 levels. This was taken all the way back to the posterior aspect of the vertebral bodies. Curve curettes were used to get behind the vertebral body and complete diskectomies were performed back to the posterior longitudinal ligament. At this point, once this was on L2 and L3 all the way out to the edge of the vertebral bodies, the large Leksell rongeur was used to resect the entire vertebral body. Just a shell of the cortical bone was left on both sides to help with the fusion mass. A curved curette was placed behind the vertebral body, between the dura, epidural bleeders and the tumor. Curved curettes, and 3-0 and 4-0 Kerrisons were used to resect the tumor along the dura. The some shells of cortical bone were left on the dura. Those could not be easily peeled off or left in place. The right-sided L3 foramen was also cleared out. The L3 nerve root was identified and this was completely decompressed if any tumor to minimize
chance of persistent L3 radiculopathy which we had before. At this point, the endplates were prepared and the 22 mm end caps were used, 1st with 3 in 3 degrees at each end cap, but this did require more lordosis to an 8-degree, end cap was used and this showed good position on AP and lateral views. After the endplates were prepared down to bleeding bone, the Vlift was packed with Vitoss and iliac crest bone graft. This was put into place confirming to be good position in AP and lateral views. Next, the anterior plate was applied. A 65-mm anterior plate and 25-mm screws were placed 1st in the L4 and then in L2. We had difficulty getting the approach safely with retraction of the aorta into the superior right-sided L2, so we left this out. The locking device was employed to lock these screws into place. Final x-rays confirmed good position of the hardware. Next, wound was copiously irrigated. Vancomycin 500 mg sprinkled into the wound. Hemostasis was ensured and then the wound was closed in layers.