# Coding round-about for COSC: Cervical Laminectomy



## martnel (Feb 9, 2011)

This is from the coding round about for CEU's for COSC.  I have tried several codes, that I thought is correct, also consulted with a colleague, but we cannot find the missing code(s), and I cannot complete the CEU.
Thisa is what is accepted so far:

721.1, 63045, 63048 x 4, 20936, 22842


OPERATIVE NOTE
PATIENT'S NAME:    							                                              ADMIT DATE:							                                                         SURGEON:										                       CHART #:										                  ROOM #:								                               ACCOUNT #:
DATE OF DICTATION: 5/23/08
DATE OF SURGERY: 5/23/08
PREOPERATIVE DIAGNOSIS:
1.   Cervical myelopathy.
POSTOPERATIVE DIAGNOSIS:
1.   Cervical myelopathy.
PROCEDURE PERFORMED:
C3 through C6 laminectomy, C3, 4, 5 and 6 lateral mass screws, instrumentation C3 to C6, fusion with bone morphogenic protein and a local autograft from a laminectomy, C3 through C6, foraminotomies C4-5, 5-6 and 6-7 bilaterally.
SURGEON(S):									                          Attending,									                            ESTIMATED BLOOD LOSS									        250 cc.										        COMPLICATIONS:									                  None.
INDICATIONS:									                     Is a gentleman with symptoms of progressive myelopathy. MRI reveals some cervical stenosis.  He also has what appears to be some deformity and flexion of his cervical spine.  Because of this it was determined he should undergo C3 through C6 cervical laminectomy and fusion.  The risks of the procedure were explained to him before including bleeding, infection, failure, spinal cord damage. He understood these risks and wished to proceed. All questions were answered.
PROCEDURE IN DETAIL:                                                                                                      The patient was smoothly intubated by Anesthesia.  He was placed in a Mayfield head holder and placed prone on the Wilson frame.  He was secured.  A localizing image was obtained for   localization and the posterior of his neck was prepped and draped in the usual manner. It was infiltrated with Marcaine with Epinephrine. A midline skin incision was undertaken. The muscles were dissected off bilaterally off of the lamina exposing the underlying lamina and the lateral masses were dissected out. Another x-ray was obtained for localization and lateral mass screws were placed bilaterally on the right and the left. All holes were checked for any breakouts. There was one breakout on the right at C5 but still there was enough good bone to accept a screw safely.  Once the screws were placed a bilateral laminectomy was then made from C3 to C6 using the Midas Rex drill drilling a trough bilaterally and lifting off the lamina en bloc. The edges of the laminectomy were then cleaned up with a Kerrison and foraminotomies were done at 4-5, and 5-6. At this point any epidural veins were bipolar coagulated. The wound was thoroughly irrigated and the joints were drilled to accept bone graft. At this point some bone morphogenic protein was packed into the joints and out laterally along the lateral masses and the local graft from the laminectomy was ground up and packed into the joints and out laterally.  At this point the rods were placed from C3 to C6 and secured. There was some difficulty placing the rod on the left but it was eventually able to be reduced into place and secured. The cap nuts were then torqued down using the supplied torque device.  The wound was irrigated and closed over a drain, closing the muscle and muscular fascia with 1-0, the subcu with 3-0 Vicryl, the epidermis with staples. The patient was then taken out of pins and taken to recovery in good condition.
I was present for all important aspects of the case
JOB #376777



05/23/08 0548 05/27/08 2003 CRH
D 05/23/08/ T  05/27/08 /CRH


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## bmeech (Feb 9, 2011)

This is what I came up with besides what you have....20930, 63020-50, 22600,
22614x2,63035-50 x2...I did not have your 63045 or the 63048x4
Hope this helps
Brenda


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## bmeech (Feb 9, 2011)

I know that does not make since due to the note states a laminECTOMY..but I coded a LaminOTOMY...But I have found several discrepancy in these test and by changing the coded as such and it came back stated..."Coded Correct"??? I have contacted AAPC about these issues when I discover them and I do not get a response back. ??  just and FYI
Brenda


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## martnel (Feb 10, 2011)

Thank you so much Brenda, this surely helped me a lot!  The codes above was not necessarily my choices, it was accepted by the system by trial and error.  I actually had the 22600 in there, but it won't accept the 22614 or 20930, which I also thought was correct.  It did accept the 63020-50 and 63035-50 x2!  Yeah!  Thank you once again! (This is not codes that I use on a daily basis...)


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## bmeech (Feb 10, 2011)

Good I am glad it helped...but do you see what I mean...these codes really do not fit the OP note...Maybe if you call/write to AAPC also and more people do that, they will go through their tests before publication...Same with the COSC test...I do not usually use these spinal codes at work on a daily basis either, which makes it hard to study for the Exam when the answers are wrong......Makes me doubt myself / skills


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