Wiki Neurosurgery coding question?

rockylopez

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Hi I am new to neurosurgery and i wanted to reach out to anyone that can help me code this surgery please. Patient had:
-removal of right C2-T2 posterior instrumentation
-New occipital to T2 right sided instrumentation
-New Occiput instrumentation
-Occipital to C3 arthodesis.

Please if anyone can help me with these code i would really appreciate it.
 
The op report states

pre op diagosis: Atlantoaxial Instability and Rhuematoid pannus

Procedure:
Removal of right C2-T2 posterior instrumentation.
New occipital to T2 right sided instrumentation.
New left occiput to C3 instrumentation.
Occipital to C3 arthodesis.
Morselized allograft.
Intraoperative fluoroscopy.
Neurophysiologic monitoring.

Anesthesia: General
Estimated blood loss (ML) : 500

No specimens in log

Once the patient was under anesthesia, baslelines MEP and SSEP were obtained. The head of fixated in the Mayfield head holder and patient was positioned with all pressure points padded. Prophylactic antibiotic was administered. Posterior neck was clipped. The area was prepped and draped in a sterile fashion. Timeout was performed. The previous posterior cervical scar was incised and incision extended superiorly towards the external occipital protuberance. Posterior cervical hardware was exposed. The occiput was also exposed in subperiosteal fashion as well as the C1 lamina. Bilateral c1 lateral mass screws were placed. On the left side, a lateral connector was used to connect a new rod going rom the occiput to C1 and connecting to the old rod below the c3 lateral mass screw. The right sided rod was removed. A new rod was extended from the occiput to T2 on the right side. Decortication of occipital bone, posterior lamina of the C1 and lateral masses at C2 and C3 was performed. Morselized allograft was placed alloing the decorticated bone. MEP and SSEP remained stable. Copious irrigation was performed. Hemostasis was ensured. Counts were verified to be correct. a sub fascial Hemovac drain was placed and secured with suture. Closure was performed with 0 vicryl in the fascia and 2-0 vicryl in the dermis. Dermobond prineo was placed on the skin. The patient was extubated and transported to PACU in stable condition.
 
Here is what I am coming up with 22595 for the arthrodesis C1 to C2 posterior
here is coder desk reference description of 22595:
Spinal arthrodesis, or fusion, may be done for conditions of herniated disc, degenerative, traumatic, and/or congenital lesions, or to stabilize fractures or dislocations of the spine. The patient is placed in a Stryker frame with a previously applied halo vest. The physician makes an incision from the occiput to the fourth or fifth vertebra. The physician exposes the posterior arch of the atlas (C1) and laminae of the axis (C2) and removes all soft tissue from bony surfaces. The upper arch of C1 is exposed and a wire loop is brought from below upward under the arch of the atlas and sutured. The physician passes the free ends through the loop, grasping the arch of C1. A graft taken from the iliac crest or other donor bone is placed against the lamina of the C2 and the arch of C1 beneath the wire. The physician passes one end of the wire through the spinous process of C2 and twists it securely into place. The retractors are removed and the incision is closed over a drain.
22600 for arthrodesis C3
22843 for posterior instrumentation per segment which included C1-T2 total of 9 segments

CDR description for code range 22842-22844

Segmental instrumentation is a construct placed with fixation not only at either end but also at the levels between. The physician makes a midline incision in the skin, fascia, and paravertebral muscles over the affected vertebrae. Multiple hooks or screws are introduced into the vertebral pedicles where fixation is needed. Dual rods, such as Harrington distraction and compression rods, are anchored to the screws or hooks. Distraction is the force that produces kyphosis and compression corrects kyphosis, the abnormal hunchback curvature of the spine. To achieve correction, the compression assembly is tightened in place before distraction is applied and secured in position. The wound is closed with layered sutures. The Harrington rod instrumentation techniques are being replaced by three-dimensional correction techniques where rods can be bent along the length and applied at any level, in rotation, with distraction and compression applied between segments. Report 22842 for fixation of three to six vertebral segments; 22843 for seven to 12 vertebral segments; and 22844 for 13 or more vertebral segments. These codes are reported in addition to codes for the primary procedure.

20930 for allograft
Wouldn't get credit for removal since this was a revision.

If the removal was replaced at the same levels with no additional then code 22849

22849
This code describes the procedures used following failure of devices such as wires, screws, cables, plates, or rods used in spinal fixation. The patient is placed in the position dictated by the failure. The physician makes a midline incision overlying the damaged section. The fascia, paravertebral muscles, and ligaments are retracted. A number of reparative techniques may be used, depending on the device and point of failure. In most cases, the device must be replaced. The physician closes the muscles, fascia, and skin with layered sutures.

I am a facility coder so I normally don't code the monitoring can't help there:)
 
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