# Extreme lateral approach for discectomy



## SHOES29 (Nov 10, 2010)

I'am trying to find the a cpt code for extreme lateral approach for lumbar discectomy.  All I can find is lateral vertebral corpectomy.  Can anyone help??


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## KKAMMERER (Nov 11, 2010)

*Xlif*

22533 arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace; lumbar
or
0195t arthrodesis, pre-sacral interbody technique, including instrumentation, imaging (when performed), and discectomy to prepare interspace, lunbar, single interspace

0171t insertion of posterior spinous process distraction device (including necessary removal of bone or ligament fro insertion and imaging guidance), lumbar: Single level

hope this helps!


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## coderguy1939 (Nov 11, 2010)

Without seeing the op report, my opinion is:

22558
22585 (for add'l interpace)
22851

and an appropriate graft code (20930, 20937 or 20938)


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## SHOES29 (Nov 11, 2010)

Thank you, thank you, thank you!!!  Both have helped!!!


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## specialtycoder (Nov 11, 2010)

Your question did not mention an arthrodesis or instrumentation being done.  Was only a discectomy done, or was it done with these other procedures?


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## SHOES29 (Nov 11, 2010)

sorry, should have been more specific.  It was 2 surgeons.  My doctor (neurosurgeon)  only did the discectomy.  The other dr. (orthopedic) did the arthrodesis.  Could I use 22533 with modifier 52 for my dr.?


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## specialtycoder (Nov 11, 2010)

If your doc did not do the arthrodesis, I would not recommend using that code.
You might consider *63056*--"transpedicular approach with decompression of....nerve root, (eg, herniated disc, single segment; lumbar (including transfacet, or lateral extraformainal approach) (*eg, far lateral herniated intervertebral disc*)."   Does that match what the op note says? 
Then, if your neurosurgeon assisted the orthopedic spine surgeon on the fusion and instrumentation, you can bill his codes as well, using 80 modifier.  Call the ortho doc's biller/coder to get their exact codes (both CPT and DX) and match them exactly. 
Since each specialty did his own procedures in this surgery, I do not see them sharing any codes as co-surgeons.


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## SHOES29 (Nov 12, 2010)

He didn't assist the ortho Dr.  He just did the lateral extracavitry approach (more anterior) for the discectomy.  And on the 2 stage surgery he only did the posterior lumbar laminectomy.  Never assisted the ortho Dr.


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## coderguy1939 (Nov 12, 2010)

The lay description of 22533 states:

The corresponding rib is dissected from the intercostal muscles and resected in one piece from the curve to the costovertebral connection. 

Did the surgeon remove a rib during this procedure?


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