D.R.
Networker
Morning All! It's been a Very long time since I have done any spine coding and my experience with it was limited. I need some help. Can I code 63030 & 63047 for this? Appreciate any advice. TIA
PROCEDURE:
1: Left L5 hemilaminotomy for L5-S1 discectomy
2: Left S1 hemilaminotomy for decompression of lateral recess stenosis
3: Left S1 neurolysis
PROCEDURE: The patient was taken to the Operating Room and after identification of the patient and the operative site, administration of antibiotics, and completion of anesthesia, the patient was prepped and draped in the prone position on a Jackson table. During this time and the entire operation, care was taken to maintain appropriate perfusion pressures during anesthesia. All bony protuberances and soft tissues were well padded in the standard fashion. Pre- and intra-operatively prophylactic antibiotics were administered according to the appropriate timing schedule. At the conclusion of the procedure the sponge and needle count were correct x2.
The incision was localized with x-ray and a spinal needle prior to incision. Marcaine 0.5% was infiltrated into the area of the incision and the paraspinal musculature. Following this, a 2cm incision was made in the skin over L5-S1 and dissection was carried down through the subcutaneous tissue and the deep fascia. A tubular retractor was placed over the L5-S1 disc space using fluoroscopy.
The burr was then utilized to create a laminotomy in the caudal aspect of the L5 left hemilamina with minimal amount of the inferior articular process resected along its medial surface. Next, a currette was utilized to elevate the ligamentum flavum off the cranial edge of the S1 lamina, thereby entering the epidural space. The 3mm Kerrison punch was utilized to perform a laminotomy of the cranial aspect of the S1 hemilamina. Next, the ligamentum flavum was easily detached and the plane between the ligamentum and the underlying dural sac easily established with the Woodson elevator. The 3mm Kerrison punch was then utilized to resect the ligamentum flavum across the entirety of the interlaminar space.
Next, the Woodson elevator was utilized to palpate the left S1 pedicle. This allowed identification of the adjacent S1 nerve root. Once the lateral aspect of the nerve root was identifiable and visualized, the 3mm Kerrison punch was used to perform partial medial undercutting of the L5-S1 facet articulation to provide indirect decompression of the S1 nerve root and access to the posterolateral aspect of the disk space.
At this point,the S1 nerve root was found to be adherent to the ventral surface of the spinal canal, so a neurolysis of the left S1 nerve root was performed. It was carefully and incrementally mobilized in a medial direction with the Penfield 4 elevator and then retracted medially with the nerve root retractor. Once the root was mobilized medially, notation was made of a large extruded nuclear fragment which had passed through a small traumatic annulotomy in the posterolateral aspect of the disk space. This annulotomy was extended with a 15 blade. The extruded fragment was grasped and then carefully teased out through the annulotomy. Once the major fragment was removed, root mobility was markedly improved. At this point, the small angled pituitary rongeur was utilized to remove a small amount of the additional protruded/extruded nuclear matter through the traumatic annulotomy. A minimal amount of the nucleus within the intervertebral disk space adjacent to the traumatic annulotomy was also removed to minimize the potential for recurrent disk herniation. Once this was completed, a catheter and syringe were used to irrigate out through the traumatic annulotomy. No additional free fragments were identified. Full S1 nerve root decompression had been achieved with restoration of nerve root mobility. The patient was Valsalva-ed and was found to have no egress of CSF. Epidural bleeding was negligible at this point and hemostasis was obtained. The wound was irrigated with antibiotic solution. Tubular retractor was removed and wound was again inspected and hemostasis was obtained.
PROCEDURE:
1: Left L5 hemilaminotomy for L5-S1 discectomy
2: Left S1 hemilaminotomy for decompression of lateral recess stenosis
3: Left S1 neurolysis
PROCEDURE: The patient was taken to the Operating Room and after identification of the patient and the operative site, administration of antibiotics, and completion of anesthesia, the patient was prepped and draped in the prone position on a Jackson table. During this time and the entire operation, care was taken to maintain appropriate perfusion pressures during anesthesia. All bony protuberances and soft tissues were well padded in the standard fashion. Pre- and intra-operatively prophylactic antibiotics were administered according to the appropriate timing schedule. At the conclusion of the procedure the sponge and needle count were correct x2.
The incision was localized with x-ray and a spinal needle prior to incision. Marcaine 0.5% was infiltrated into the area of the incision and the paraspinal musculature. Following this, a 2cm incision was made in the skin over L5-S1 and dissection was carried down through the subcutaneous tissue and the deep fascia. A tubular retractor was placed over the L5-S1 disc space using fluoroscopy.
The burr was then utilized to create a laminotomy in the caudal aspect of the L5 left hemilamina with minimal amount of the inferior articular process resected along its medial surface. Next, a currette was utilized to elevate the ligamentum flavum off the cranial edge of the S1 lamina, thereby entering the epidural space. The 3mm Kerrison punch was utilized to perform a laminotomy of the cranial aspect of the S1 hemilamina. Next, the ligamentum flavum was easily detached and the plane between the ligamentum and the underlying dural sac easily established with the Woodson elevator. The 3mm Kerrison punch was then utilized to resect the ligamentum flavum across the entirety of the interlaminar space.
Next, the Woodson elevator was utilized to palpate the left S1 pedicle. This allowed identification of the adjacent S1 nerve root. Once the lateral aspect of the nerve root was identifiable and visualized, the 3mm Kerrison punch was used to perform partial medial undercutting of the L5-S1 facet articulation to provide indirect decompression of the S1 nerve root and access to the posterolateral aspect of the disk space.
At this point,the S1 nerve root was found to be adherent to the ventral surface of the spinal canal, so a neurolysis of the left S1 nerve root was performed. It was carefully and incrementally mobilized in a medial direction with the Penfield 4 elevator and then retracted medially with the nerve root retractor. Once the root was mobilized medially, notation was made of a large extruded nuclear fragment which had passed through a small traumatic annulotomy in the posterolateral aspect of the disk space. This annulotomy was extended with a 15 blade. The extruded fragment was grasped and then carefully teased out through the annulotomy. Once the major fragment was removed, root mobility was markedly improved. At this point, the small angled pituitary rongeur was utilized to remove a small amount of the additional protruded/extruded nuclear matter through the traumatic annulotomy. A minimal amount of the nucleus within the intervertebral disk space adjacent to the traumatic annulotomy was also removed to minimize the potential for recurrent disk herniation. Once this was completed, a catheter and syringe were used to irrigate out through the traumatic annulotomy. No additional free fragments were identified. Full S1 nerve root decompression had been achieved with restoration of nerve root mobility. The patient was Valsalva-ed and was found to have no egress of CSF. Epidural bleeding was negligible at this point and hemostasis was obtained. The wound was irrigated with antibiotic solution. Tubular retractor was removed and wound was again inspected and hemostasis was obtained.