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laminectomy troubles

  1. Default laminectomy troubles
    Medical Coding Books
    How would you guys bill this? There are quite a few bundled services so what do you think it most importantly, the most accurate, but also, the most prudent as far as reimbursement.

    procedures performed in may 2010 according to the op report:

    1. L5 laminectomy.
    2. S1 laminectomy.
    3. Neurolysis, L5-S1 nerve root on the right side (but two nerve roots).
    4. Neurolysis, L5-S1 nerve root on contralateral side.
    5. Osteotomy L5-S1, left side.
    6. Osteotomy L5-S1, contralateral side.
    7. Removal of midline scar tissue overlying L5-S1, thecal sac level and neurolysis.
    8. Bilateral foraminotomies, L5.
    9. Bilateral foraminotomies, S1.
    10. Use of intraoperative operating microscope and microsurgical technique.
    11. Use of intraoperative C-arm fluoroscopy for verification of level and also verification of proper foraminal decompressions bilaterally.
    12. Use of intraoperative spinal monitoring consisting of EMG monitoring and somatosensory-evoked potential monitoring.

    Any help or insight on these specific codes would be very appreciated because our physician is starting to do alot more MILD proceudres. THANKS

  2. Default Laminectomy help
    The laminectomies bundle into the osteotomy, which you would code 22214. The scar revision is bundled into the osteotomy as well. Check your cci edits. As far as the neurolysis, if the neurolysis is internal, whoch i suspect it is since your doc used microscope, then look at 64727, this includes the use of microscope.

    You can't really look at prudent for reimbursement, you have to look at proper coding for the case and the carrier.

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