# Spinal Fusion



## Partha (Oct 19, 2009)

Please suggest CPT codes:

1. Facet fusion *TruFUSE* L5-S1 bilaterally.
2. *Forminotomy L4-L5 on left posterior fusion at L4-L5 with Aspen device and bone graft.*
3. *Reduction of spondylosis L4-5*

Patient positioned prone, back was prepped and draped . Percu. K wire was placed in facet *L5-S1 *after localizing the facet on AP and lat & oblique views. This was followed by dilatation of facet insertion of cannula. Then drilling the facet joints on 2 sides was done and *insertion of bone dowel*. Once this was completed, both wounds were thoroughly washed and closed with interrupted sutures and couple of Monocryl to the skin. 

A *midline incision *was made between the spinous process at L4-5 and L5-S1. Sharp dissection was carried down to skin and subcu tissues. *Paravertebral dissection was carried down to expose lamina of L4 and L5 *with a shaver and currette. Ligamentum flavum was lifeted on left side off the inferior surface and dissection carried down to interlaminar space.

*Foraminotomy* was performed, nerve hook was passed to confirm. This was followed by *insertion of a dilating device *between the interspinous process L4 & L5 and the area was decorticated. This was followed by insertion after dilatation of interspinous for spondylosis at L4-5 grade 1 as well as locking it in place between the spinous process with *bone graft inserted in circular part of Aspen device. *

Once left in place, the facets & interforamninal spaces were wide opened and *spondylosis at L5 was also reduced*. Once this was accomplished, washout of wounds was performed and wound closed.


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## RebeccaWoodward* (Oct 19, 2009)

I'll give it a shot....

Facet fusion TruFUSE L5-S1 bilaterally-Per the AANS, recommended code is *22899* since there is not a code specifically created for this procedure.

Forminotomy L4-L5 (*63030*) on left posterior fusion at L4-L5 with Aspen device (*22841*) and bone graft (*what kind?)*


Reduction of spondylosis L4-5-I don't know that a code exists for this.


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