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Hi,
I have researched and found nothing on if we can bill 63047 X2 for separate incisions for laminectomy. Below is the operative report. I had researched previously and thought I had documentation that shows we cannot bill this way, now I cannot find. Any input would be greatly appreciated...Thanks!
PREOPERATIVE DIAGNOSES;
1. L4?L5 and L3?L4 spinal stenosis with foraminal stenosis.
2. Possible disk herniation L3?L4 and L4?L5.
POSTOPERATIVE DIAGNOSES:
1. L3?L4 and L4?L5 spinal stenosis with bilateral foraminal stenosis.
2. Calcified disks at L3?L4 and L4?L5.
OPERATION PERFORMED:
1. L3?L4 laminectcmy and bilateral micrcforaminotomy from the left.
2. L4-L5 laminectomy and bilateral microforaminotomy from the right
through a separate incision.
3. Use of operative microscope for microsurgical dissection of fine
neural structures.
OPERATIVE INDICATION: The patient presented with symptoms of bilateral leg pain, left worse than the right. The patient?s MRI scan revealed lumbar spinal stenosis L3?L4 and L4?L5. He failed to respond to nonsurgical treatment. He was recommended to consider lumbar laminectomy and foraminotomy. Since it appeared he had disk herniation on the opposite side, it was recommended that we perform the procedure through separate incision on the side of the disk herniation. Prior to the operation, the operative procedure, alternatives, potential risks of surgery were discussed at length with the patient including, but not limited to infection, nerve injury, spinal fluid leakage, scar tissue formation, failure to completely relieve all the pain symptoms. He indicated understanding of the above and wished to proceed with surgery.
OPERATIVE NOTE: The patient was taken to the operating room awake. He was given general endotracheal anesthesia. lie was given preoperative antibiotics and Decadron. He was then carefully placed in the prone position. Chest and abdomen supported on 2 chest rolls, bony prominences padded and taped into position. The lumbar area was clipped, prepped with Betadine soap, painted with Betadine, and draped in the usual sterile fashion. The patient?s name, identity, site of operation confirmed with the circulating nurse. I initially performed the surgery on the right side at the L4?L5 level. Using the C-arm, the L4-L5 level was marked. A 2 cm incision was made one finger off the midline. Incision was carried down through the lumbar fascia. Tubular dilators were docked onto the lamina of L4?5 followed by placement of a 9 cm x 18 mm tubular retractor over the L4?5 level on the right. Level was confirmed on the x-ray. The Anspach drill was used to thin out the inferior and superior aspect of the lamina of L4 and L5. Kerrison punch was used to remove the lamina. The thickened ligamentum flavum was removed initially on the right side. The L5 nerve root was severely compressed in the neural foramen, and this was decompressed by removing the bone over the neural foramen up to the medial aspect of the pedicle of L5. The L4-L5 disk appeared to be calcified and could not really be removed. Tubular retractor was retracted towards the opposite side, and the L5 nerve root was decompressed on the opposite side by performing a foraminotomy, removal of bone and ligament up to the edge of the dura. Hemostasis was obtained, Gelfoam was placed over the area of the laminotomy, tubular retractor was withdrawn while obtaining hemostasis. The lumbar fascia was reapproximated using 2?0 Vicryl, subcutaneous layer reapproximated using 2?0 Vicryl. Skin was closed using staples. On the left side, a 2 cm incision was made over the L3?L4 level. The dilators were then placed over the L3-L4 level, followed by placement of a 9 cm x 18 mm tubular retractor. The Anspach drill was used to thin out the inferior and superior aspect of lamina of L3?L4. The bone was then removed. Ligamentum flavum was thickened and removed over the dura. The dura was quite compressed on both sides. The bone removal was performed with decompression of the L4 nerve roots bilaterally. Inspection of the disk revealed a calcified disk without any soft disk herniation to remove. Once the bone and ligament had been removed, the neural foramen were well decompressed. Bleeding was controlled using Gelfoam and thrombin powder. A piece of Gelfoam was laid over the laminotomy site. The retractor was then removed while obtaining hemostasis. The lumbar fascia was reapproximated using 2?0 Vicryl, subcutaneous layer reapproximated using 2?0 Vicryl. Skin was closed
I have researched and found nothing on if we can bill 63047 X2 for separate incisions for laminectomy. Below is the operative report. I had researched previously and thought I had documentation that shows we cannot bill this way, now I cannot find. Any input would be greatly appreciated...Thanks!
PREOPERATIVE DIAGNOSES;
1. L4?L5 and L3?L4 spinal stenosis with foraminal stenosis.
2. Possible disk herniation L3?L4 and L4?L5.
POSTOPERATIVE DIAGNOSES:
1. L3?L4 and L4?L5 spinal stenosis with bilateral foraminal stenosis.
2. Calcified disks at L3?L4 and L4?L5.
OPERATION PERFORMED:
1. L3?L4 laminectcmy and bilateral micrcforaminotomy from the left.
2. L4-L5 laminectomy and bilateral microforaminotomy from the right
through a separate incision.
3. Use of operative microscope for microsurgical dissection of fine
neural structures.
OPERATIVE INDICATION: The patient presented with symptoms of bilateral leg pain, left worse than the right. The patient?s MRI scan revealed lumbar spinal stenosis L3?L4 and L4?L5. He failed to respond to nonsurgical treatment. He was recommended to consider lumbar laminectomy and foraminotomy. Since it appeared he had disk herniation on the opposite side, it was recommended that we perform the procedure through separate incision on the side of the disk herniation. Prior to the operation, the operative procedure, alternatives, potential risks of surgery were discussed at length with the patient including, but not limited to infection, nerve injury, spinal fluid leakage, scar tissue formation, failure to completely relieve all the pain symptoms. He indicated understanding of the above and wished to proceed with surgery.
OPERATIVE NOTE: The patient was taken to the operating room awake. He was given general endotracheal anesthesia. lie was given preoperative antibiotics and Decadron. He was then carefully placed in the prone position. Chest and abdomen supported on 2 chest rolls, bony prominences padded and taped into position. The lumbar area was clipped, prepped with Betadine soap, painted with Betadine, and draped in the usual sterile fashion. The patient?s name, identity, site of operation confirmed with the circulating nurse. I initially performed the surgery on the right side at the L4?L5 level. Using the C-arm, the L4-L5 level was marked. A 2 cm incision was made one finger off the midline. Incision was carried down through the lumbar fascia. Tubular dilators were docked onto the lamina of L4?5 followed by placement of a 9 cm x 18 mm tubular retractor over the L4?5 level on the right. Level was confirmed on the x-ray. The Anspach drill was used to thin out the inferior and superior aspect of the lamina of L4 and L5. Kerrison punch was used to remove the lamina. The thickened ligamentum flavum was removed initially on the right side. The L5 nerve root was severely compressed in the neural foramen, and this was decompressed by removing the bone over the neural foramen up to the medial aspect of the pedicle of L5. The L4-L5 disk appeared to be calcified and could not really be removed. Tubular retractor was retracted towards the opposite side, and the L5 nerve root was decompressed on the opposite side by performing a foraminotomy, removal of bone and ligament up to the edge of the dura. Hemostasis was obtained, Gelfoam was placed over the area of the laminotomy, tubular retractor was withdrawn while obtaining hemostasis. The lumbar fascia was reapproximated using 2?0 Vicryl, subcutaneous layer reapproximated using 2?0 Vicryl. Skin was closed using staples. On the left side, a 2 cm incision was made over the L3?L4 level. The dilators were then placed over the L3-L4 level, followed by placement of a 9 cm x 18 mm tubular retractor. The Anspach drill was used to thin out the inferior and superior aspect of lamina of L3?L4. The bone was then removed. Ligamentum flavum was thickened and removed over the dura. The dura was quite compressed on both sides. The bone removal was performed with decompression of the L4 nerve roots bilaterally. Inspection of the disk revealed a calcified disk without any soft disk herniation to remove. Once the bone and ligament had been removed, the neural foramen were well decompressed. Bleeding was controlled using Gelfoam and thrombin powder. A piece of Gelfoam was laid over the laminotomy site. The retractor was then removed while obtaining hemostasis. The lumbar fascia was reapproximated using 2?0 Vicryl, subcutaneous layer reapproximated using 2?0 Vicryl. Skin was closed