ericka123449
Guest
Hello!
I've been having issues understanding when to use 27279 vs 0775T. I understand that both codes are determined based on the transfixation of the sacroiliac joint. To me...this definitely is a 0775T however, I've gotten so many denials for this code that it's making me doubt the coding. Here's the operative note!
The patient was placed on the operative table in the prone position on a radiolucent table. MAC sedation was used. The lumbosacral region was prepped first with alcohol, then Chloraprep x2 and allowed to appropriately dry before the sterile towels and drapes were positioned. Betadine impregnated drape was placed directly over the surgical field. An oblique fluoroscopic view was used to visualize the right sacroiliac joint and the skin surface was marked at the level of the S1 foramen at the PSIS. A curved tip #22-gauge spinal needle was inserted percutaneously into the mid aspect of the right sacroiliac joint using fluoroscopic guidance. Following negative aspiration, 5 mL of 0.5% Marcaine with Epinephrine was injected. The needle was withdrawn to the subcuticular tissues where an additional 15mL of 0.5% Marcaine with Epinephrine was injected. A 2mm Steinmann pin was placed into the joint along the same path as the previously inserted spinal needle. A 1.5 cm posterior midline incision was made over the SI joint, followed by dissection using the LinQ scalpel guide and scalpel down to the ligamentous structure without difficulty or complication. Bleeding was controlled with Bovie without complication. LinQ tissue dilators were placed into the joint using the Steinmann pin as a guide under fluoroscopic guidance. The inner dilator was removed, leaving the outer dilator as a working channel. A joint decorticator was advanced down the working channel by tapping with a mallet to prepare a cavity in the joint to receive the structural bone allograft implant. The decorticator was removed with minimal bleeding and no tissue residue in the device. The allograft implant has a graft window and retrograde ridges that were packed with demineralized bone matrix to increase the opportunity for bone fusion. After the allograft was placed, the working channel was removed leaving only the allograft implant in the patient. This was confirmed with fluoroscopy. The wound was irrigated with betadine solution and then vigorously irrigated with saline. I then packed the wound with Flowseal 5ml and monitored for any additional bleeding. The wound was then packed with GelFoam for prevention of post operative bleeding. The surgery was concluded by closing the wound layers with intermittent 2-0 Vicryl sutures deep following by intermittent 2-0 Vicryl sutures subcutaneously, and finally staples. Sterile dressing was applied. The patient went to the recover room in satisfactory condition.
Any advice would be amazing.
I've been having issues understanding when to use 27279 vs 0775T. I understand that both codes are determined based on the transfixation of the sacroiliac joint. To me...this definitely is a 0775T however, I've gotten so many denials for this code that it's making me doubt the coding. Here's the operative note!
The patient was placed on the operative table in the prone position on a radiolucent table. MAC sedation was used. The lumbosacral region was prepped first with alcohol, then Chloraprep x2 and allowed to appropriately dry before the sterile towels and drapes were positioned. Betadine impregnated drape was placed directly over the surgical field. An oblique fluoroscopic view was used to visualize the right sacroiliac joint and the skin surface was marked at the level of the S1 foramen at the PSIS. A curved tip #22-gauge spinal needle was inserted percutaneously into the mid aspect of the right sacroiliac joint using fluoroscopic guidance. Following negative aspiration, 5 mL of 0.5% Marcaine with Epinephrine was injected. The needle was withdrawn to the subcuticular tissues where an additional 15mL of 0.5% Marcaine with Epinephrine was injected. A 2mm Steinmann pin was placed into the joint along the same path as the previously inserted spinal needle. A 1.5 cm posterior midline incision was made over the SI joint, followed by dissection using the LinQ scalpel guide and scalpel down to the ligamentous structure without difficulty or complication. Bleeding was controlled with Bovie without complication. LinQ tissue dilators were placed into the joint using the Steinmann pin as a guide under fluoroscopic guidance. The inner dilator was removed, leaving the outer dilator as a working channel. A joint decorticator was advanced down the working channel by tapping with a mallet to prepare a cavity in the joint to receive the structural bone allograft implant. The decorticator was removed with minimal bleeding and no tissue residue in the device. The allograft implant has a graft window and retrograde ridges that were packed with demineralized bone matrix to increase the opportunity for bone fusion. After the allograft was placed, the working channel was removed leaving only the allograft implant in the patient. This was confirmed with fluoroscopy. The wound was irrigated with betadine solution and then vigorously irrigated with saline. I then packed the wound with Flowseal 5ml and monitored for any additional bleeding. The wound was then packed with GelFoam for prevention of post operative bleeding. The surgery was concluded by closing the wound layers with intermittent 2-0 Vicryl sutures deep following by intermittent 2-0 Vicryl sutures subcutaneously, and finally staples. Sterile dressing was applied. The patient went to the recover room in satisfactory condition.
Any advice would be amazing.