ewheeler
Contributor
My Interventional pain management doc is doing minute man procedures in the ASC. He wants to bill 22612, 22840, 20930. Has anyone billed these procedures? Can you take a look at the note and see if coding looks correct? The ASC want to bill as an unlisted code, and not as a fusion. I'd really appreciate any assistance. Thanks!
| ARTHRODESIS OF L4/L5 VERTEBRAL INTERSPINOUS SPACE Description of Operation: Patient was identified by myself and informed consent was reviewed. The patient was transported to the operating room. After the induction of general anesthesia, the patient was positioned prone on a Wilson frame with appropriate protective padding. The patient's back was shaved, prepped and draped in the usual fashion. AP and lateral fluoroscopy were utilized throughout the procedure. Skin marks were made on the lateral aspect of the back corresponding to the inferior edge of the L4 spinous process, the superior edge of the L5 spinous process, and the L4-L5 facets. The skin and muscle were then infiltrated with 1% Lidocaine with epinephrine at the surgical site. An open 3cm incision was made on the direct lateral aspect of the patient's back, corresponding with the level of the L4-L5 facets previously marked. A guide wire was then inserted through the incision and into the L4-L5 interspinous space, guided by fluoroscopy. Soft tissue dilators of gradually increasing size were then inserted over the guide wire, creating a pathway to the posterior spine. A first working sleeve was then inserted over the dilators and brought into contact with the lateral aspect of the spinous processes at this level. The dilators were removed. The L4-5 facet and posterior interspace landmarks were confirmed through direct visualization by accompanied light source in conjunction with fluoroscopy with the working sleeve in place. The bone rasp, inserted over the guide wire, was utilized to reduce the hypertrophied facet joint to allow docking of the sleeve against the spinous processes. . With the bone tap in place, the L4-5 interspinous ligament was removed and the spinous processes decorticated to bleeding bone. The tap was advanced into the interspinous-interlaminar space decorticating the space to prepare the fusion site. The sizing holes of the tap were visualized under fluoroscopy, and the appropriate implant size 10mm was determined. Both the tap and the guide wire were removed and the first sleeve was left in place again. The L4-5 facet and posterior interspace landmarks were confirmed through direct visualization by accompanied light source in conjunction with fluoroscopy again with the dilators in place. The facet-TP junction was then decorticated with a hand held bone tap. The 10mm insertion adapter was attached to the distal end of the implant bone tap. A 10mm posterior fusion device was attached to the implant inserter, filled with morselized allograft bone, and the implant with the bone was then inserted into the L4-L5 interspinous and interlaminar space through the working sleeve using the inserter. After the fixed plate of the implant came in contact with the spinous process-lamina junction, the extension plate of the implant was deployed on the contralateral side. Rigid fixation of the arthrodesis site was achieved by advancing the fixed plate until both plates were embedded into bone. The inserter and the sleeve were then removed. AP and lateral fluoroscopy confirmed good positioning of the arthrodesis hardware and appropriate alignment of the fusion site. The subcutaneous tissue was closed with 2-0 vicryl suture. The skin was closed with 3-0 nylon suture in interrupted fashion. A sterile dressing was then applied. The patient tolerated the procedure well and left the operating room in stable condition |