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Smith Peterson osteotomy w/ facetectomy, fusion

aekukla

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Can anyone please explain how to code this? My surgeon tells me that the PSO is so small that anything above and beyond (the facetectomy) is separately reportable. Can i code 63047 and 22214 at the same level? Or is the removal of the facet joint coded with 63012 since the diagnosis is spondylolisthesis?


"The skin was sharply incised. Bovie electrocuatery was used to dissect out the transverse process of L4 and L5 along with the L4-L5 facet joint. Meticulous care was used to dissect out the L3-L4 facet joint (i think this is a typo) without disrpting the facet capusule. Deep retractors were plaed. C-arm was brought in for locatlization. We were found to be at the appropriate levels. Once the approach has been done, we proceeded with the decompression.

A leksell roungeur was used to remove the L4 spinous process and as much as we were able to remove the L4 lamina. An angled Chroma-Line curette was then used to disect the ligamentum flavum off the residual lamina and remove adhesions. The combination of 3 amd 4 Kerisons were used to remove the rest of the lamin, removing all central stenosis. We then used the Woodson to ry to feel the lateral recess. Thesere was noted to be significant lateral recess stenosis at the L4-5, and teh 3 and 4 Kersions were used to remove this. Once the central and lateral recess stenosis was improved we then turned to the foramina. The patient did have significant preoperative right leg pain. We then did a Smith-Peterson osteotomy of the right L4-5. This was done by placing a Woodson underneath the pars of L4 and using a bur across the pars. The inferior articular process was then broken off. This resection was then taken flush to the L4 pedicle and also to the left side. We then decompressed the lateral recess stenosis at L4-L5 and once again did the Smith peterson osteotomoy on the left L4-L5 by taking a Midas bur across the pars, removing the inferior articular process, and then using Kerrison rongeurs to remove the residual superior articular process and anything caudal to the L4 pedicle. At this point, i felt our decompression was very thorough. We irrigated out the surgicl wound."

This was then followed by fusion at L4-5.

Help is really appreciated. Between what my surgeon tells me and what i am finding on google i am getting very mixed messages.
 
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