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Orthopedic Coding Alert

Reader Question:

Select Appropriately for Spinal Instrumentation

Published on Wed Aug 10, 2011

Question: For a child with congenital scoliosis, our surgeon performed growth rod revision and reinsertion of spinal fixators. Arthrodesis or fusion was not done. This is planned every six months as the child grows. The operative note reads as follows: "An incision was made over the distal 4 screws. This was carried through skin and subcutaneous. The fascia was incised laterally over each of the set of 2 screws. All four set screws were removed. Another approximately 5 cm incision was made over the couplers. This was carried through skin and subcutaneous. Again, separate lateral  fascial incisions were made over the couplers themselves. The set screws were removed. The rods were then removed from each lower end of the construct. A right rod was placed followed by the left rod. These were locked into place on the coupler and we distracted right and then left at the bottom of the [...]
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