Hello fellow coders,
I have an op report for a decompressive laminectomy with foraminotomies. The dr is wanting to code this as 63005 but that code says without foraminotomies and I can't find a code that just includes the foraminotomies. 63047 includes both facetectomy and foraminotomy. I am new to neurosurgery and is in need of some guidance. PLEASE HELP!!!!!
OPERATIVE PROCEDURE:1) L3-4 decompressive laminectomy with foraminotomies. 2) use of intraoperative fluroscopy for less than one hour
The patient was then placed prone on the operating table with all pressure points padded. A midline skin incision was placed on the patient's back and the incision line was prepped and draped in usual sterile fashion. The skin was copiously infused with Marcaine 0.5% with epinephrine. The skin was incised using a #10 scalpel blade, and all soft tissues were dissected with electorcautery. Self-retaining retractors were placed and the lumbodorsal fascia was incised with electrocautery; the spinous processes of L2, L3, and L4 were exposed using subperiosteal dissection out to the facet joings. After using lateral fluoroscopy to tidentify the appropriate level, the deeper self-retaining retractores were placed and the spinous processes of L3 and L4 were removed using a DeLee Horsley bone biter. The rest of the lamina down to the a ligamentum flavum was incised with a #15 blade over a dental tool. The ligamentum lavum was removed in a medial to lateral fashion using various sized Kerrison punches. The operation was complete with the dura was pulsatlile and translucent blue in color. Foraminotomies were made utiltizing Kerrison punches and their adequacy was tested using a Woodson elevator in the lateral recess.
Hemostatsis was achieved and the wound was irrigated with antibiotic infused saline. The wound was then closed in layers as follows: Lumbodorsal fascia was closed with 0-Vicryl interrupted suture, the deep fascia was closed with 2-0 vicryl interrupted suture, the dermis was closed 3-0 vicryl interrupted suture, and the skin was closed with staples.
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