Results 1 to 3 of 3

Lumbar Laminotomy w/ fusion and excision of cyst.

  1. #1
    Monticello, NY
    Question Lumbar Laminotomy w/ fusion and excision of cyst.
    Medical Coding Books
    I'm new to spine coding and am looking for much needed help from some experienced spine coders.

    My doctor performed a posterolateral fusion with instrumention.

    I'm coding this with 22612, +22614, +22842-52 but am not confident. I'm also missing a code for the excision of the cyst.

    Thank you so much for any help sent my way!

    Here's his note:

    Operation: L4-L5 laminotomy, left. L4-5 excision of synovail cyst, left. Left
    L4-5 segmental instrumentation and posterior dynamic stabilization.

    Procedure: After informed consent was confirmed... She was subsequently positioned in a prone position, and an incision over the L4 and L5 levels was confirmed using intraoperative radiography. The area was subsequently sterilely prepped and draped.

    Incision was made and subperiosteal dissection was made down the spinous process on the patient's left and right side down to the facet joints and transverse processes of the L4 and L5 levels bilaterally, and top-loading Dynesis screw connectors were then placed consisting of single level Dynesis implants from the Zimmer set. Once the Dynesis posterior dynamic stabilization instrumentation was in place and adequately tensioned to ensure stabilization, attention was turned to decompression.

    The laminotomy was made at the trailing edge of the L4 lamina. The ligamentum flavum was noted to be densely adherent to the underlying dura and was carefully burnished from the underlying dura using a small ball burnisher. Decompression was continued to the lateral recess, where a large, multilobulated synovial cyst was appreciated in the left subarticular lateral recess. This cyst was excised and sent for specimen. The courses of the L4 exiting nerve root as well as the L5 traversing nerve root were then palpated, and after decompression eonsisting of the scarred, adherent underlying ligamentum flavum, the L4 and L5 nerves wer noted to be easily mobile and free of compression.

    The area was then copiously irrigated with bacitracin-containing irrigant and the fascia was closed with #1 Vicryl sutures in a figure-of-eight pattern...

  2. #2
    Default Lumbar Lami
    I work for a Neurosurgeon, these are the codes I use for this op:

    63267, 22612, 22851 (Peak graft) 22840, make sure you code for the xray as well with -26. Hope this helps, good luck!

  3. #3
    Monticello, NY
    Thank you so much!!

    I can't believe how much I am learing every day.

Similar Threads

  1. bone grafting for lumbar fusion
    By boyett in forum Orthopaedics
    Replies: 3
    Last Post: 10-21-2014, 11:31 AM
  2. 2012 Lumbar Fusion Help
    By caromissunc1 in forum Orthopaedics
    Replies: 7
    Last Post: 04-27-2012, 03:30 AM
  3. help coding w/lumbar fusion new @ these..
    By RHENZ06ily in forum General Surgery
    Replies: 0
    Last Post: 09-29-2011, 12:28 PM
  4. Posterior Lumbar Interbody Fusion
    By jcroly in forum Orthopaedics
    Replies: 5
    Last Post: 02-12-2010, 07:57 AM
  5. Repeat posterolateral fusion lumbar
    By ammontagano in forum Orthopaedics
    Replies: 1
    Last Post: 06-30-2009, 09:58 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.