kcoyne1109
New
- Messages
- 7
- Location
- Conway, SC
I have a question on this op report. Since only a laminectomy is completed with the fusion and not facetectomy and foraminotomy would you bill 63015 or would you still bill 63045, 63048 with the fusion codes 22600, 22614? I attached an operative report. Please advise.
Procedure:
1) Placement and removal of Mayfield head holder
2) Posterior cervical laminectomy, C3-4, C4-5, C5-6, C6-7
3) Posterior cervical fusion C3-4, C4-5, C5-6, C6-7
4) Posterior segmental instrumentation C3-7
5) Application of allograft bone for purposes of fusion
6) Application of locally harvested bone graft for purposes of fusion
Midline posterior cervical incision was performed, followed by sharp dissection down to level of fascia. Bovie and bipolar electrocautery were utilized to maintain adequate hemostasis. At this point, the posterior cervical fascia was sharply released from the spinous process of C7, and the ligamentum nuchae was split in midline in order to maintain a relatively hemostatic plane. The subfascial paraspinal musculatures were carefully elevated in a subperiosteal manner from the underlying spinous processes, lamina, lateral masses of C3-C7. The wound was thoroughly irrigated. Fluoroscopy confirmed appropriate levels. Utilizing anatomic landmarks, screw tract trajectories were drilled in the lateral masses bilaterally of C3, C4, C5, C6, and C7. Ball-tipped feeler probe was utilized to confirm safe trajectories. The screws and appropriately contoured rods were then placed. The left C5 screw had poor purchase and was removed before final construct. The remainder of the bilateral screws from C3-7 were noted to have adequate purchase. AP and lateral radiographs confirmed acceptable instrumentation and alignment.. Once adequate hemostasis had been obtained, we turned our attention to the planned laminectomy. A high-speed side-cutting bur was utilized to drill troughs at the margin of the lamina and lateral masses of C4, C5, and C6. A high-speed side-cutting bur was utilized to take down the cranial portion of C7 and caudal portion of C3. A combination of nerve hook, microcurette, and #1 Kerrison was utilized to release ligamentum flavum and any adhesions in the drill troughs. Prior to removal of the lamina, it was confirmed with the CRNA that the patient's MAPs were being held above 85. The caudal portion of the C3 lamina, entire C4, C5, and C7 lamina, and the cranial portion of C7 lamina were carefully removed en-bloc utilizing a Woodson elevator to release any adhesions in the epidural space. Repeat neuromonitoring values following laminectomy were performed and noted to be stable. The resected lamina were morselized and mixed with allograft bone for later use during posterolateral fusion. The wound was thoroughly irrigated with normal saline. The facet joints and lateral masses of C3, C4, C5, C6, and C7 were carefully decorticated in order to allow for bone grafting and posterolateral fusion. A mix of the previous resected laminar bone which had been morselized, in combination with allograft bone substitute was carefully placed in the decorticated facet joints, and in the posterior lateral recesses dorsal to the cervical facet joints. The laminectomy defect was carefully investigated to ensure there was no graft material in this area.
Procedure:
1) Placement and removal of Mayfield head holder
2) Posterior cervical laminectomy, C3-4, C4-5, C5-6, C6-7
3) Posterior cervical fusion C3-4, C4-5, C5-6, C6-7
4) Posterior segmental instrumentation C3-7
5) Application of allograft bone for purposes of fusion
6) Application of locally harvested bone graft for purposes of fusion
Midline posterior cervical incision was performed, followed by sharp dissection down to level of fascia. Bovie and bipolar electrocautery were utilized to maintain adequate hemostasis. At this point, the posterior cervical fascia was sharply released from the spinous process of C7, and the ligamentum nuchae was split in midline in order to maintain a relatively hemostatic plane. The subfascial paraspinal musculatures were carefully elevated in a subperiosteal manner from the underlying spinous processes, lamina, lateral masses of C3-C7. The wound was thoroughly irrigated. Fluoroscopy confirmed appropriate levels. Utilizing anatomic landmarks, screw tract trajectories were drilled in the lateral masses bilaterally of C3, C4, C5, C6, and C7. Ball-tipped feeler probe was utilized to confirm safe trajectories. The screws and appropriately contoured rods were then placed. The left C5 screw had poor purchase and was removed before final construct. The remainder of the bilateral screws from C3-7 were noted to have adequate purchase. AP and lateral radiographs confirmed acceptable instrumentation and alignment.. Once adequate hemostasis had been obtained, we turned our attention to the planned laminectomy. A high-speed side-cutting bur was utilized to drill troughs at the margin of the lamina and lateral masses of C4, C5, and C6. A high-speed side-cutting bur was utilized to take down the cranial portion of C7 and caudal portion of C3. A combination of nerve hook, microcurette, and #1 Kerrison was utilized to release ligamentum flavum and any adhesions in the drill troughs. Prior to removal of the lamina, it was confirmed with the CRNA that the patient's MAPs were being held above 85. The caudal portion of the C3 lamina, entire C4, C5, and C7 lamina, and the cranial portion of C7 lamina were carefully removed en-bloc utilizing a Woodson elevator to release any adhesions in the epidural space. Repeat neuromonitoring values following laminectomy were performed and noted to be stable. The resected lamina were morselized and mixed with allograft bone for later use during posterolateral fusion. The wound was thoroughly irrigated with normal saline. The facet joints and lateral masses of C3, C4, C5, C6, and C7 were carefully decorticated in order to allow for bone grafting and posterolateral fusion. A mix of the previous resected laminar bone which had been morselized, in combination with allograft bone substitute was carefully placed in the decorticated facet joints, and in the posterior lateral recesses dorsal to the cervical facet joints. The laminectomy defect was carefully investigated to ensure there was no graft material in this area.