# Help with spine surgery



## AMBarber (Sep 2, 2010)

During the exposure of a thoracic lami for excision of abscess my surgeon encountered a paraspinal abscess.  I have 3 coding options.  Which would you use?

1. Code the lami (63266) and 20005 (Incision of soft tissue abscess, deep or complicated)

2. Code the lami and 22010 (Incision and drainage, open, of deep abscess (subfascial), posterior spine, cervial, thoracic or cervicothroacic)

3. Consider it part of the lami.


From the op note: 

...to expose the thoracic spine including spinous process and lamina of T2, T3 and T4 and exposing the thoracic spine, a paraspinal abscess was entered and a large amount of purulent material was identified, sent for culture and irrigated clean.  Once the paraspinal abscess had been debrided and irrigated, a Leksell rongeur and 2&3 Kerrison punches were used to complete the laminectomy at T2, T3 and medial facetectomy.  There was a large epidural abscess, which was entered and removed using microsurgical techniques and stripped off the dura...... 

Oh would you code the operating microscope? 

Thanks! 

Anna


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## Amy Carroll (Sep 2, 2010)

*acarroll*

Per NCCI Guidelines, the abscess is not separately billable.


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## RebeccaWoodward* (Sep 2, 2010)

Option #3-I agree that this would be inclusive.  You can charge for 69990, also.

*Operating Microscope*
1. The Internet-Only Manuals (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 20.4.5 (Allowable Adjustments) limits the reporting of use of an operating microscope (CPT code 69990) to procedures described by CPT codes 61304-61546, 61550-61711, 62010-62100, *63081-63308,* 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64891 and 64905-64907. CPT code 69990 should not be reported with other procedures even if an operating microscope is utilized. CMS guidelines for payment of CPT code 69990 differ from CPT Manual instructions following CPT code 69990. The NCCI bundles CPT code 69990 into all surgical procedures other than those listed in the Medicare Claims Processing Manual. Most edits do not allow use of NCCI-associated modifiers.


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## AMBarber (Sep 20, 2010)

Thanks! That's what we were leaning towards.


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