kguglielmi
Contributor
Hello! My surgeon did a procedure and we can not decide what code to use for it. He described doing a "vertebrectomy" (corpectomy) but his approach was posterior. There are no posterior corpectomy codes. We have been told to use 63102, but that specifically says it is for a lateral extracavitary approach, which I have read several detailed descriptions of, and I don't believe that's what he did. We were told that code "allows for posterior and later access to the vertebra" but I don't agree. Am I wrong? I'll include the part of his op note that pertains to the corpectomy.
The patient was brought to the operative room and appropriately identified. Patient was intubated and ventilated at the IR suite for the embolization. He was brought to the operative room after the embolization of the tumor. Patient came with a Foley's catheter inserted in the emergency department. The patient was then placed over Wilson frame in prone positioning. The arms were placed on arm support in supine position. His joints were padded and protected. X-ray fluoroscopy was used to localize the spine of L2 down to L5. A midline skin incision between those levels was planned. Appropriate prepping and draping was then performed. The skin was infiltrated with lidocaine with epinephrine. A #10 blade was used to incise the skin. Self-retaining retractor was then applied. Bovie electrocautery was used to The tissue sharply. Dissection of the paraspinal muscles in a periosteal fashion was then performed to expose the spine, laminae, facet joints of L2, L3, L4, and L5. Gelpi's retractors were used to retract the tissue wide open. The tumor was identified by the naked eye at L3. The tumor was found to destroy the facet joint of L2-L3 and L3-L4 on the right. O arm application was then used verify the levels. Stryker navigation was used to insert the bilateral pedicle screws at L2 and bilateral pedicle screws above L4. The pedicles where cannulated using navigated awl at the beginning. Then self-tapping Xia navigated screws were inserted. Repeat spin was used to verify the insertion of the pedicle screws which was found to be satisfactory. Xia screws (Stryker/K2M) were used. At L2 we used 4.5 x 40 mm screws and at L4 we used 6.5 x 40 mm screws. Then I paid attention for the decompression. Wide laminectomy at both L2-3 and L4 was performed. Most of the tumor was distracting the right facet joints of L2-L3 and L3-L4. I took down the facet of L2-L3 and L3-L4. The nerve root of the right L3 and L4 were exposed. Nerve roots were protected. Then I removed the tumor using ultrasonic aspirator. Microsurgical techniques were then used to remove the bone. Then approaching the vertebral body of L3 through the pedicles of L3 which was destroyed by the tumor I performed vertebrectomy using high-speed drill, ultrasonic aspirator, osteotome, and pituitary rondure. Part of the vertebral body on the left side was intact so I left it alone. During the process of removing the tumor the thecal sac was retracted. We had durotomy with mild CSF leak and I sutured it using 4-0 Nurolons. Then a very generous decompression of L3 and the tumor was performed. All the visualized tumor was removed. Then I performed L2-L3 discectomy L4-L5 discectomy and I prepared the endplates for the cage insertion.
Should I use the code for laminectomy for spinal tumor instead? Any help would be appreciated!
The patient was brought to the operative room and appropriately identified. Patient was intubated and ventilated at the IR suite for the embolization. He was brought to the operative room after the embolization of the tumor. Patient came with a Foley's catheter inserted in the emergency department. The patient was then placed over Wilson frame in prone positioning. The arms were placed on arm support in supine position. His joints were padded and protected. X-ray fluoroscopy was used to localize the spine of L2 down to L5. A midline skin incision between those levels was planned. Appropriate prepping and draping was then performed. The skin was infiltrated with lidocaine with epinephrine. A #10 blade was used to incise the skin. Self-retaining retractor was then applied. Bovie electrocautery was used to The tissue sharply. Dissection of the paraspinal muscles in a periosteal fashion was then performed to expose the spine, laminae, facet joints of L2, L3, L4, and L5. Gelpi's retractors were used to retract the tissue wide open. The tumor was identified by the naked eye at L3. The tumor was found to destroy the facet joint of L2-L3 and L3-L4 on the right. O arm application was then used verify the levels. Stryker navigation was used to insert the bilateral pedicle screws at L2 and bilateral pedicle screws above L4. The pedicles where cannulated using navigated awl at the beginning. Then self-tapping Xia navigated screws were inserted. Repeat spin was used to verify the insertion of the pedicle screws which was found to be satisfactory. Xia screws (Stryker/K2M) were used. At L2 we used 4.5 x 40 mm screws and at L4 we used 6.5 x 40 mm screws. Then I paid attention for the decompression. Wide laminectomy at both L2-3 and L4 was performed. Most of the tumor was distracting the right facet joints of L2-L3 and L3-L4. I took down the facet of L2-L3 and L3-L4. The nerve root of the right L3 and L4 were exposed. Nerve roots were protected. Then I removed the tumor using ultrasonic aspirator. Microsurgical techniques were then used to remove the bone. Then approaching the vertebral body of L3 through the pedicles of L3 which was destroyed by the tumor I performed vertebrectomy using high-speed drill, ultrasonic aspirator, osteotome, and pituitary rondure. Part of the vertebral body on the left side was intact so I left it alone. During the process of removing the tumor the thecal sac was retracted. We had durotomy with mild CSF leak and I sutured it using 4-0 Nurolons. Then a very generous decompression of L3 and the tumor was performed. All the visualized tumor was removed. Then I performed L2-L3 discectomy L4-L5 discectomy and I prepared the endplates for the cage insertion.
Should I use the code for laminectomy for spinal tumor instead? Any help would be appreciated!