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Thread: Neurosurgery - New to this type of coding

  1. #1

    Default Neurosurgery - New to this type of coding

    AAPC: Back to School
    New to this type of coding, please help.
    Pre-Op Dx 1. L1 vertebral osteomyelitis 2. pathologic vertebral compression fracture 3. Metastatic breast carcinoma 4. L2 bilateral pedicle fractures 5. L5 left-sided spondylolysis
    6. Thoracolumbar kyphosis

    Post-Op dx: the same as above
    Procedure performed
    1. L1 corpectomy
    2. Anterior spinal fusion, T12-L2
    3.Placement of anterior interbody spacer
    4. Bilateral posterior osteotomy T11 to L2
    5. Laminectomy T12-L2
    6.Posterior spinal fusion
    7. Autograft bone grafting
    8. Allograft bone graft
    9. posterior segmental spinal instrumentation, T11-L3
    10. Intraoperative cranial traction
    11. Application and removal of Gardner-Wells tongs
    12. Pleural repair
    13. T12 harvest for autograft bone.

    Description of Procedure:
    A midline incision extending from T11-L3 and dissected out to the tips of the transverse processes at each level. We confirmed out levels radiographically. Once the exposure was complete, we dissected out over the left T12 rib and resected it. there was a tear in the pleura during this time, we placed a red rubber catheter into the chest cavity and sewed the pleura over the red rubber catheter, sucking out any air that had been accumulated. A very tight waterproof pleural repair was effected. We then filled the wound with water and performed several valsalvas and no air was seen to escape from the pleurotomy. We then performed posterior osteotomy/inferior facetectomies at all levels from L2-T11 in order to obtain autograft bone., exposed the facet joints to denude the cartilage, enhance flexibilty of the spine, and exposedlandmarks for pedicle screw placement. Screws were placed from L3-T11. the pedicle fracture at L2 were readily cannulated and screws were placed across then without difficulty. we then confirmed our levels radiographically follwerd by stimulatio with pedicle stimulation that all were felt to be in acceptable position. We then performed a laminectomy from T12-L2. Bilateral posterior osteotomies/resction of the pars/complete foraminectomies at T12-L1 and L1-L2 bilaterally until there was a complete pedicle to pedicle decompression. Following this, we knocked off the transverse process on both sides and placed temporary rods. we worked down both pedicles and along the sides of the vertebral body. We then decancellated the vertebral body until reaching the ventral aspect of the vertebral body on the patient's right side where we encountered a significant amount of purulence. This was aggressively debrided. The remaining portion of the body was resected down to the disk above and below. The diskes were cut through down to the level of the endplate and below. We then selected a size 18 PEEk Medtronic boomerang cage, packed it with autograft bone and vancomycin powder and compressed over the cage. It sat in a bit of an oblique position, however itwas tightly compressed against the vertebral body above and below and it could not be moved while grabbing it with a clamp. This was felt to be stable. we then measured, cut, and contoured final rods and reduced them into the screws, compressed over them, and copiously irrigated the wound with antibiotic laden sterile saline. The motors data remained stable throughout. we then took the T12 rib and split it in half, placed it over the laminectomy defect after covering the exposed dura with DuraGen and Evicel. the remaining autograft bone was packed from T11-L3, and cross-linkwas placed. we then placed a deep drain and closed the wound in layers. the patient awoke without event and was found to be completely neurologically normal in the operating room, and she was taken to the recovery room in stable condition. I was present for the entirety of the procedure. josh Gilliam assisited as necessary due to the complex nature of the procedure. In fact, there were no other qualified assistants available.

    63047, 63048 x 2, 22214, 22216 x3, 63087, 22842, 22612, 22614 x4, 20936, 20930 & 20661(inclusive)

    Thank You for your time and help.

  2. #2


    I see several issues here. Let me explain.

    1) "Anterior spinal fusion, T12-L2" - you do not have this coded, was this intentional? I would assume this would be:


    Was there a co-surgeon? I could not tell based on the Op Report, if so you would need the 62 modifier.

    2) "L1 corpectomy" - I would believe this to be 63090.

    3). "Placement of anterior inter body spacer" - you did not have this coded as well. I see reference in the dictation regarding the PEEK Cage, although I am not sure of the levels it spanned. Was it just one cage or one at each fusion level as I would assume. I would assume it to be:

    22851 T12/L1
    22851 L1/2

    You will have coding issues with the Posterior Lami's (63047/63048) and Osteotomies (22214/22216). Per the CCI Edits, "Code 63047 is a component of Column 1 code 22214 but a modifier is allowed to differentiate between the services provided". If the osteotomies were done so they could complete the laminectomies it would be considered inclusive. If they were not, I would recommend the 59 modifier.

    I am not sure why you billed the 63087, I assume you confused it with 63090? The rest looks fine.

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