Surgeon performs an ALIF with a lumbar cage then closes. During the same operative session, turns the patient over and does the following:
PROCEDURE: The patient was rotated in the prone
position after completing the anterior portion of the procedure. Care was taken to pad all bony
prominences and make sure the axilla was free of compressive support.
The overlying the lumbar spine was peripherally draped with plastic
barrier drapes, prepped with Chloraprep and circumferentially draped in
the usual sterile fashion. At this point, biplane C-arm image
intensification was brought on the field and the bodies of L5 and S1
were centered and localized to the field itself. Utilizing the
guidance two small skin incisions were made parallel in the paraspinal
region approximately 3 cm off the midline at the area felt to represent
the L5-S1 segment. Under fluoroscopic guidance, Jamshidi needles were
inserted into the left pedicle of L5. Guide wires were then placed and
tissue protectors were inserted. The holes were tapped and 5.5 x 45 mm
screw were inserted into the left L5 pedicle. This same procedure was repeated for the left S1 pedicle were the left S1 screw was 6.5 x 45. During this and the
entire procedure, the patient was under neurophysiologic monitoring
from Impulse Monitoring. All guidewires were stimulated and excess of 40 mA. All screws stimulated and the values were given above. The portals
were irrigated. The rod was passed
percutaneously and the screw heads tightened torqued into position and
the inserting clips were removed. Final x-rays show excellent
alignment and placement of pedicle screws as well as the anterior
construct. The portals were irrigated and subcutaneous tissue was
closed with interrupted 2-0 Vicryl. Skin was closed with Dermabond.
Dry sterile dressing was applied. The patient was returned to the
recovery room bed and extubated without incident.
How would you code the posterior portion of the procedure? Would 22840 and 77002 be appropriate or an unlisted procedure code?
PROCEDURE: The patient was rotated in the prone
position after completing the anterior portion of the procedure. Care was taken to pad all bony
prominences and make sure the axilla was free of compressive support.
The overlying the lumbar spine was peripherally draped with plastic
barrier drapes, prepped with Chloraprep and circumferentially draped in
the usual sterile fashion. At this point, biplane C-arm image
intensification was brought on the field and the bodies of L5 and S1
were centered and localized to the field itself. Utilizing the
guidance two small skin incisions were made parallel in the paraspinal
region approximately 3 cm off the midline at the area felt to represent
the L5-S1 segment. Under fluoroscopic guidance, Jamshidi needles were
inserted into the left pedicle of L5. Guide wires were then placed and
tissue protectors were inserted. The holes were tapped and 5.5 x 45 mm
screw were inserted into the left L5 pedicle. This same procedure was repeated for the left S1 pedicle were the left S1 screw was 6.5 x 45. During this and the
entire procedure, the patient was under neurophysiologic monitoring
from Impulse Monitoring. All guidewires were stimulated and excess of 40 mA. All screws stimulated and the values were given above. The portals
were irrigated. The rod was passed
percutaneously and the screw heads tightened torqued into position and
the inserting clips were removed. Final x-rays show excellent
alignment and placement of pedicle screws as well as the anterior
construct. The portals were irrigated and subcutaneous tissue was
closed with interrupted 2-0 Vicryl. Skin was closed with Dermabond.
Dry sterile dressing was applied. The patient was returned to the
recovery room bed and extubated without incident.
How would you code the posterior portion of the procedure? Would 22840 and 77002 be appropriate or an unlisted procedure code?