Meljmichon
Guest
Here is the following OP note from a Partial Corpectomy, Anterior Diskectomy and Fusion. I am curious if you think that the 22551 Fusion is included with the 63081 Corpectomy. Medicare CCI is stating a modifier may be needed to be billed together. Anyone have any idea if this is included? The AAOS does not state that it is.
POSTOPERATIVE DIAGNOSIS: C5-C6 stenosis.
PROCEDURE PERFORMED:
1. C5, C6, C7 partial corpectomies.
2. C5-C6 and C6-C7 anterior diskectomy and fusions using DBM and Biomet
see-through cages.
3. C5, C6, C7 anterior spinal instrumentation using Biomet MaxAn anterior
cervical plating system.
PROCEDURE IN DETAIL: Under general anesthesia, the patient was positioned
supine on a Jackson table. All bony prominences were well padded. The
anterior cervical region was then prepped and draped in sterile fashion.
Using landmarks of the cricoid cartilage, mandible and sternal notch,
curvilinear incision was made in the left anterior cervical triangle and
standard Smith-Robinson approach made to the anterior cervical spine.
Self-retaining retractors were placed beneath the longus colli after
confirmation of the position of our dissection was confirmed with a
crosstable fluoroscopic image. A marker was in the body of C7. The C6-C7
interval was then marked with a Bovie. The operative microscope was then
draped and brought into the operative field. Caspar pins were placed at C5
and C6, entering the C5-C6 disk space through a square shaped annulotomy
with the aid of an operating microscope. Disk material was removed to the
level of the posterior longitudinal ligament which was divided. Partial
corpectomies were required to decompress the central and lateral horns of
the canal at the inferior border of C5 and superior border of C6. Once it
was felt there was no further compression on either the foraminal level or
the central portion of the canal, decompression was felt to be complete.
Attention was then turned to the fusion portion of procedure at C5-C6. The
endplates were prepared to a blushing surface and sized to 7 mm in height.
A 7 mm Biomet see-through plate filled with DBM was inserted. Final
position was found satisfactory in both AP and lateral fluoroscopic images.
This composed the decompression and fusion portion of the procedure at
C5-C6. A Caspar pin at C5 was removed and placed at C7. Again, with the
aid of an operative microscope, the C6-C7 interval was then entered to the
level of the posterior longitudinal ligament and identical to C5-C6 central
decompression was needed to be performed via a partial corpectomy
posteriorly. Once the central canal was decompressed, the foramen was
decompressed sufficient to allow nerve to easily pass out the foramens.
Decompression was felt to be complete.
Attention was then turned to the fusion portion procedure at C6-7. Again
the interval was prepared and sequentially dilated to 7 mm. A 7 mm Biomet
see-through cage filled with DBM was then inserted. The final position was
found to be satisfactory in both AP and lateral fluoroscopic images. This
composed the decompression and fusion portion of the procedure at C6-C7.
Attention was then turned to the instrumentation portion of the procedure.
A 24 mm Biomet MaxAn plate was then secured to the bodies of C5, C6 and C7.
Final position of the screw plate was found to be satisfactory on both AP
and lateral fluoroscopic images. Final locking of the screws was then
performed under direct visualization. The wound was then irrigated and
hemostasis maintained. The wound was closed in layers and sterilely
dressed. Overall the procedure was well tolerated. The patient was
transferred to the recovery room in stable condition.
POSTOPERATIVE DIAGNOSIS: C5-C6 stenosis.
PROCEDURE PERFORMED:
1. C5, C6, C7 partial corpectomies.
2. C5-C6 and C6-C7 anterior diskectomy and fusions using DBM and Biomet
see-through cages.
3. C5, C6, C7 anterior spinal instrumentation using Biomet MaxAn anterior
cervical plating system.
PROCEDURE IN DETAIL: Under general anesthesia, the patient was positioned
supine on a Jackson table. All bony prominences were well padded. The
anterior cervical region was then prepped and draped in sterile fashion.
Using landmarks of the cricoid cartilage, mandible and sternal notch,
curvilinear incision was made in the left anterior cervical triangle and
standard Smith-Robinson approach made to the anterior cervical spine.
Self-retaining retractors were placed beneath the longus colli after
confirmation of the position of our dissection was confirmed with a
crosstable fluoroscopic image. A marker was in the body of C7. The C6-C7
interval was then marked with a Bovie. The operative microscope was then
draped and brought into the operative field. Caspar pins were placed at C5
and C6, entering the C5-C6 disk space through a square shaped annulotomy
with the aid of an operating microscope. Disk material was removed to the
level of the posterior longitudinal ligament which was divided. Partial
corpectomies were required to decompress the central and lateral horns of
the canal at the inferior border of C5 and superior border of C6. Once it
was felt there was no further compression on either the foraminal level or
the central portion of the canal, decompression was felt to be complete.
Attention was then turned to the fusion portion of procedure at C5-C6. The
endplates were prepared to a blushing surface and sized to 7 mm in height.
A 7 mm Biomet see-through plate filled with DBM was inserted. Final
position was found satisfactory in both AP and lateral fluoroscopic images.
This composed the decompression and fusion portion of the procedure at
C5-C6. A Caspar pin at C5 was removed and placed at C7. Again, with the
aid of an operative microscope, the C6-C7 interval was then entered to the
level of the posterior longitudinal ligament and identical to C5-C6 central
decompression was needed to be performed via a partial corpectomy
posteriorly. Once the central canal was decompressed, the foramen was
decompressed sufficient to allow nerve to easily pass out the foramens.
Decompression was felt to be complete.
Attention was then turned to the fusion portion procedure at C6-7. Again
the interval was prepared and sequentially dilated to 7 mm. A 7 mm Biomet
see-through cage filled with DBM was then inserted. The final position was
found to be satisfactory in both AP and lateral fluoroscopic images. This
composed the decompression and fusion portion of the procedure at C6-C7.
Attention was then turned to the instrumentation portion of the procedure.
A 24 mm Biomet MaxAn plate was then secured to the bodies of C5, C6 and C7.
Final position of the screw plate was found to be satisfactory on both AP
and lateral fluoroscopic images. Final locking of the screws was then
performed under direct visualization. The wound was then irrigated and
hemostasis maintained. The wound was closed in layers and sterilely
dressed. Overall the procedure was well tolerated. The patient was
transferred to the recovery room in stable condition.