# Do I have enough to bill 63047 with 22633?



## skorkfranks (Sep 26, 2012)

DX: 724.02, 756.12

 Once all the screws have been inserted, we shall start to do the decompression at L4-L5, it's extremely tight and we shall have to do bilateral decompression, because of the spinal stenosis.  
We then,perform TLIF by creating foraminal windows removing the superior facet of L5
and inferior facet of L4.  Reclining the dura sac to the midline to get access
to the disc, coagulate some epidural  vessels and perform thorough discectomy.  
We shall then impact some bone graft coming from the facetectomy in the
front and then autograft MTF Synthes allograft   in the anterior third that has
good  stability, this would be oriented in a coronal  fashion in order to be
able to recreate some lordosis.   
 We shall then do facet fusion on the opposite side make sure, there is no compression of any nerve by placing a Woodson on Bernard  probing  in the the different foramina L4-L5 foraminal on both sides.  All the nerves are  perfectly intact.   We shall then do
posterolateral  fusion on the facet on the left thigh and on the trans-
processes on both sides.

Thanks!


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## moodymom (Oct 29, 2012)

I dont feel that you have enough. It seems that he only did min to prep space for fusion. The key to reporting decompression is correlating the correct number to every root level being decompressed. hope this helps.


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## lodawnyoung (Oct 29, 2012)

I agree, that the physician only did the work to prepare the interspace which is included in the 22633.


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## teridmac (Mar 7, 2013)

I was under the impression that in order to code a 63047 with a 22633 a foraminotomy had to be documented because foraminotomies were not necessary components to the TLIF/PLIF (as they require lam/facetectomies but not necessarily nerve decompression) Any thoughts on this?


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