bmeech
Networker
My question is the Hemi-Laminectomy portion (without facetectomy, foraminotomy or discectomy)
Would the level be counted as C3 & C4 & C5 or would it be C3-C4 & C4-C5== 63001 or 63015, Per Insurance denial they are stating it should be 63015 (?)
Per OP note
The patient was brought to the operating room, intubated and lines placed per anesthesiology. The patient was then turned prone in the head placed in the Mayfield head holder. The neck was shaved and was sterilely prepped and draped in usual fashion. A timeout was done and a midline incision was made in the posterior cervical spine. Subcutaneous tissue was dissected using electrocautery. The dorsal fascia was incised using electrocautery. Standard subperiosteal paraspinous muscle dissection was performed to expose the lamina and lateral facets from C3-C5. Self-retaining retractors were placed. The levels were confirmed using lateral C-arm fluoroscopy. Pilot holes were then drilled in the C3, C4, C5 facets bilaterally. 12 mm Synthes synapse screws were then placed in these levels bilaterally. Arthrodesis of the C3–4, C4–5 facet joints was performed bilaterally. An appropriate size rod was placed in the lateral mass screws bilaterally and torqued appropriately in a neutral position. Attention was then paid to decompression. Bilateral hemilaminotomies were done from C3-C5. The central lamina was then removed en bloc from C3-C5. Additional laminectomy was performed bilaterally using Kerrison punches until the central canal was well decompressed. Epidural hemostasis was achieved using FloSeal and electrocautery. The lamina that was removed was morcellized and placed as autograft on the posterior lateral masses from C3-C5. A Hemovac drain was brought out through a separate stab incision. Vancomycin was placed in the incision and then the incision was closed in multiple layers using interrupted Vicryls suture placed in multiple layers followed by staples for the skin.
Per my research
2022 Terminology Change: “Interspace”
Revisions have been made to address confusion regarding the term “level” and how it relates to an individual boney “segment” of the spine vs the “interspace.”
In order to eliminate confusion as to what is specifically being addressed by the procedure code, the term “level” has been replaced with the term “segment” in many of the code descriptors, parenthetical notes and guidelines.
Arthrodesis implies a fusion of a "motion segment",, and a motion segment refers to two adjacent vertebrae and the intercalary disk (in other words, two segments and the interspace between them)
Would the level be counted as C3 & C4 & C5 or would it be C3-C4 & C4-C5== 63001 or 63015, Per Insurance denial they are stating it should be 63015 (?)
Per OP note
The patient was brought to the operating room, intubated and lines placed per anesthesiology. The patient was then turned prone in the head placed in the Mayfield head holder. The neck was shaved and was sterilely prepped and draped in usual fashion. A timeout was done and a midline incision was made in the posterior cervical spine. Subcutaneous tissue was dissected using electrocautery. The dorsal fascia was incised using electrocautery. Standard subperiosteal paraspinous muscle dissection was performed to expose the lamina and lateral facets from C3-C5. Self-retaining retractors were placed. The levels were confirmed using lateral C-arm fluoroscopy. Pilot holes were then drilled in the C3, C4, C5 facets bilaterally. 12 mm Synthes synapse screws were then placed in these levels bilaterally. Arthrodesis of the C3–4, C4–5 facet joints was performed bilaterally. An appropriate size rod was placed in the lateral mass screws bilaterally and torqued appropriately in a neutral position. Attention was then paid to decompression. Bilateral hemilaminotomies were done from C3-C5. The central lamina was then removed en bloc from C3-C5. Additional laminectomy was performed bilaterally using Kerrison punches until the central canal was well decompressed. Epidural hemostasis was achieved using FloSeal and electrocautery. The lamina that was removed was morcellized and placed as autograft on the posterior lateral masses from C3-C5. A Hemovac drain was brought out through a separate stab incision. Vancomycin was placed in the incision and then the incision was closed in multiple layers using interrupted Vicryls suture placed in multiple layers followed by staples for the skin.
Per my research
2022 Terminology Change: “Interspace”
Revisions have been made to address confusion regarding the term “level” and how it relates to an individual boney “segment” of the spine vs the “interspace.”
In order to eliminate confusion as to what is specifically being addressed by the procedure code, the term “level” has been replaced with the term “segment” in many of the code descriptors, parenthetical notes and guidelines.
Arthrodesis implies a fusion of a "motion segment",, and a motion segment refers to two adjacent vertebrae and the intercalary disk (in other words, two segments and the interspace between them)