I billed a 22630 with 63047 & 63048 which is bundled. The carrier paid as bundled and the surgeon wants me to appeal because she did a TLIF and states that on the op notes she listed "further decompression was warranted and necessary" I don't find those exact words in her documentation however, looking at the description of a TLIF, would this warrant further decompression and justify an appeal?
A transforaminal lumbar interbody fusion (called a TLIF) is essentially like an extended PLIF. It was developed in response to some of the technical problems with a PLIF procedure. The main difference between the two spine fusion procedures is that the TLIF approach to the disc space is expanded by removing one entire facet joint (whereas a PLIF is usually done on both sides by only taking a portion of each of the paired facet joints).
Transforaminal lumbar interbody fusion description
By removing the entire facet joint, visualization into the disc space is improved and more disc material can be removed. It should also provide for less nerve retraction. Because one entire facet is removed it is only done on one side. Removing the facet joints on both sides of the spine would result in too much instability.
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