# Lumbar Laminotomy w/ fusion and excision of cyst.



## Tanya.DeSimone (Mar 20, 2009)

I'm new to spine coding and am looking for much needed help from some experienced spine coders.

My doctor performed a posterolateral fusion with instrumention.  

I'm coding this with 22612, +22614, +22842-52 but am not confident.  I'm also missing a code for the excision of the cyst.

Thank you so much for any help sent my way!

Here's his note:

Operation:  L4-L5 laminotomy, left. L4-5 excision of synovail cyst, left. Left 
L4-5 segmental instrumentation and posterior dynamic stabilization.

Procedure:  After informed consent was confirmed...  She was subsequently positioned in a prone position, and an incision over the L4 and L5 levels was confirmed using intraoperative radiography.  The area was subsequently sterilely prepped and draped.

Incision was made and subperiosteal dissection was made down the spinous process on the patient's left and right side down to the facet joints and transverse processes of the L4 and L5 levels bilaterally, and top-loading Dynesis screw connectors were then placed consisting of single level Dynesis implants from the Zimmer set.  Once the Dynesis posterior dynamic stabilization instrumentation was in place and adequately tensioned to ensure stabilization, attention was turned to decompression.

The laminotomy was made at the trailing edge of the L4 lamina.  The ligamentum flavum was noted to be densely  adherent to the underlying dura and was carefully burnished from the underlying dura using a small ball burnisher.  Decompression was continued to the lateral recess, where a large, multilobulated synovial cyst was appreciated in the left subarticular lateral recess.  This cyst was excised and sent for specimen.  The courses of the L4 exiting nerve root as well as the L5 traversing nerve root were then palpated, and after decompression eonsisting of the scarred, adherent underlying ligamentum flavum, the L4 and L5 nerves wer noted to be easily mobile and free of compression.  

The area was then copiously irrigated with bacitracin-containing irrigant and the fascia was closed with #1 Vicryl sutures in a figure-of-eight pattern...


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## sugargirl (Mar 21, 2009)

*Lumbar Lami*

I work for a Neurosurgeon, these are the codes I use for this op:

63267, 22612, 22851 (Peak graft) 22840, make sure you code for the xray as well with -26.  Hope this helps, good luck!


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## Tanya.DeSimone (Mar 23, 2009)

Thank you so much!!

I can't believe how much I am learing every day.


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