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Neurosurgery - Can someone please help me

  1. #1
    Default Neurosurgery - Can someone please help me
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    Can someone please help me on what code to use. Here's the procedure.

    1. T11-T12 extrapedicular left-sided biopsy of epidural & foraminal mass with partial resection of the T11 & T12 rib heads, as well as partial resection of T12 pedicle.
    2. Use of intraoperative microscope with extradural microsurgical dissection.

    Thanks for any advice!!!!!

  2. #2
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    I don't know that that there is enough information to provide a code. I'm assuming this was done through a posterior approach since you mentioned the resection of the T11/T12 rib heads. Was a biopsy performed? If so, what did pathology report? Was a laminectomy performed? If possible, it would be helpful to see the op note.

  3. #3
    Default Here's the OP Note. Thanks for your help!!!!!
    PREOPERATIVE DIAGNOSES:
    1. T11-T12 epidural and left foraminal mass.
    2. Castleman disease.
    POSTOPERATIVE DIAGNOSES:
    1. T11-T12 epidural and left foraminal mass.
    2. Castleman disease.
    PROCEDURES:
    1. T11-T12 extrapedicular left-sided biopsy of epidural and
    foraminal mass with partial resection of the T11 and T12 rib
    heads, as well as partial resection of T12 pedicle.
    2. Use of intraoperative microscope with extradural microsurgical
    dissection.
    3. Use of intraoperative C-arm x-ray.
    4. Use of Stryker Luxor minimally invasive retractor.

    PROCEDURE IN DETAIL:
    The patient was taken to the operating room, underwent a general
    anesthesia, endotracheal intubation. Subsequently was positioned
    prone on a Wilson frame in the Jackson table. We proceeded to
    obtain a localizing x-ray after having placed 2 needles; 1 at the
    L3 level, and 1 at the T12 level in the midline. Lateral lumbar x-
    rays were then obtained and proceeded to count up until the level,
    which was identified as T11-T12. At that site we then marked a 2.5-
    cm incision that was about 2 cm lateral to the midline. After
    prepping and draping the skin in the usual sterile fashion, we
    proceeded to infiltrate the skin with 1% lidocaine. We then
    proceeded to place a Steinmann pin at the level in the center of our
    marked incision, and we obtained another lateral x-ray and
    identified again that we were at the T11-T12 level. Once this was
    identified, we then proceeded with opening of the incision with a
    #10 blade, which was carried down through the skin, and subcutaneous
    tissue down to the fascia, which was also incised with a #10 blade.
    We then proceeded with blunt dissection down to level of the laminae
    and rib head at T11-T12. We then proceeded to place our Stryker
    Luxor retractor tubes, and proceeded to dilate the soft tissues
    around that area up until the retractor was docked on the laminae,
    and the rib head at T11-T12. A 6 cm retractor was then put in place
    and attached with the light source, and the retractor was attached
    to the attachment to the table. We then proceeded to obtain another
    lateral lumbar x-ray to verify that we were at the adequate level,
    which was the case. We then proceeded to dissect the soft tissue
    using the Bovie cautery, and the pituitary rongeur up until we were
    able to identify the bone at the rib head and laminae at T11 and
    T12. Of note is that we elected to proceed more laterally and to
    proceed with an extrapedicular biopsy as this appeared to be a safer
    access, and we would avoid causing any type of pressure on the
    spinal cord. We proceeded to resect part of the rib head at T11 and
    at T12. We identified the pedicle of T12. A thick inflammatory
    mass that appeared to be adherent to the soft tissue structures was
    identified at T11-12. We were unable to visualize any neurovascular
    element and we proceeded to take a few bites of the mass using a
    small pituitary rongeur. Some of these were sent for frozen
    pathology, which did reveal an inflammatory or a low-grade
    lymphoproliferative process. The pathologist was unable to tell on
    the frozen section whether or not we were dealing with Castleman
    disease or a low grade malignancy. As such, we then elected to
    proceed and resect further biopsy specimens. In the process we did
    notice the intercostal nerve at that level that was inadvertently
    injured, and cut as it was scarred down and had significant amount
    of inflammatory tissue around it, and was unable to be
    differentiated from the surrounding structures. Once an other
    specimen of a few millimeters was then resected in a piecemeal
    fashion, we then proceeded to achieve adequate hemostasis using the
    bipolar cautery as well as FloSeal, followed by profuse irrigation
    with antibiotic impregnated saline solution. We did use the
    intraoperative microscope during resection of the deeper specimen.
    We also spared the laminae __________proceeding with laminectomy
    again to avoid causing possible damage close to the spinal cord as
    the mass appeared to be significantly vascular, and adherent to
    neighboring soft tissues. Once adequate hemostasis obtained, we
    then proceeded to remove our tubular retractor after profuse
    irrigation with impregnated saline solution. We proceeded to
    closure in the usual fashion using 0-Vicryl interrupted suture for
    the fascia, 3-0 Vicryl interrupted suture for subcutaneous tissue,
    and a 3-0 Monocryl subcuticular suture for the skin.

  4. #4
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    Leaning towards 63276 and 69990.

  5. #5
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    Thank you so much for your help. I appreciate your help with this and also the other ones you have helped me with. You're awesome!!!!

  6. #6
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    I appreciate that. I'm not always on the money but that's what so great about this forum...we can "talk it out". I've learned alot from this forum, too!

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