Meljmichon
Guest
I have been trying to figure out the difference between the Laminotomy vs Laminectomy. We are having issues where the Surgeon is indicating 63047 Laminectomy is performed but throughout the Op note states he does a 63030 Laminotomy. Can you read this OP note and tell me if you think the Laminectomy should be billed. I know people have said they are Diagnosis Driven however they often perform Microdiskectomies along with the Laminotomy/Laminectomy so i end up with the Herniated Disc Diagnosis along with the Stenosis. I found an article stating that the Laminectomy includes removal of the Traversing Flavum. He states in the OP note that this is removed during the Laminotomy. So i am very confused. If you can provide any help it would be greatly appreciated. OP note below.
PREOPERATIVE DIAGNOSES:
1. L4-5 and L5-S1 bilateral lateral recess and foraminal stenosis.
2. Left L5-S1 foraminal disk herniation.
POSTOPERATIVE DIAGNOSES: Same.
PROCEDURE PERFORMED:
1. Bilateral L4-5 and L5-S1 foraminotomies, medial facetectomies.
2. Left L5-S1 microdiskectomy.
PROCEDURE IN DETAIL: Under general anesthesia, the patient was positioned prone
on a Jackson table. Bony prominences were well padded. Lumbar region was
prepped and draped in sterile fashion. Using landmarks of the iliac crest,
posterior superior iliac spine, and spinous processes, a longitudinal incision
was made in the midline and centered over the L5 lamina. A standard bilateral
approach to the laminas of L4 through S1 was then performed. Cross-table
fluoroscopic imaging confirmed the position of our dissection with a marker
underneath the lamina of L4 at the L4-5 interval.
The operative microscope was then draped, brought in the operative field.
Standard laminotomies were performed at all 4 foramens in identical fashion by
performing a laminotomy in the inferior border beginning at L5 on the right and
removing the traversing flavum, identifying the traversing nerve root,
decompressing lateral recess via the partial medial facetectomy. Foramens were
decompressed sufficient to allow Penfield 3 to easily pass out the foramen. The
floor of the canal was inspected on the right at both levels and on the left at
L4-5 and found to be free of any encroachment from disk protrusion or bulging.
At those 3 levels, the laminotomy and foraminotomies were simply performed to
decompress the canal and foramens. On the left at L5-S1, however, there was
noted to be foraminal and posterolateral subligamentous disk herniation, which
was removed through a cruciate annulotomy. Once it was felt the floor of the
canal and the foramen were patent and again, no encroachment on traversing or
exiting nerve root, decompression was felt to be complete. The only difference
again from all 4 foraminotomies was the left L5-S1 which was performed a
microdiskectomy. There was moderate amount of generalized bleeding which was
controlled with FloSeal and bipolar cautery; however, it was felt that as he had
4 foraminotomies the patient should stay overnight. Drain was placed for that
reason as well. The wound was then closed in layers and sterilely dressed.
Overall procedure was well tolerated. The patient was transferred to the
recovery room in stable condition.
PREOPERATIVE DIAGNOSES:
1. L4-5 and L5-S1 bilateral lateral recess and foraminal stenosis.
2. Left L5-S1 foraminal disk herniation.
POSTOPERATIVE DIAGNOSES: Same.
PROCEDURE PERFORMED:
1. Bilateral L4-5 and L5-S1 foraminotomies, medial facetectomies.
2. Left L5-S1 microdiskectomy.
PROCEDURE IN DETAIL: Under general anesthesia, the patient was positioned prone
on a Jackson table. Bony prominences were well padded. Lumbar region was
prepped and draped in sterile fashion. Using landmarks of the iliac crest,
posterior superior iliac spine, and spinous processes, a longitudinal incision
was made in the midline and centered over the L5 lamina. A standard bilateral
approach to the laminas of L4 through S1 was then performed. Cross-table
fluoroscopic imaging confirmed the position of our dissection with a marker
underneath the lamina of L4 at the L4-5 interval.
The operative microscope was then draped, brought in the operative field.
Standard laminotomies were performed at all 4 foramens in identical fashion by
performing a laminotomy in the inferior border beginning at L5 on the right and
removing the traversing flavum, identifying the traversing nerve root,
decompressing lateral recess via the partial medial facetectomy. Foramens were
decompressed sufficient to allow Penfield 3 to easily pass out the foramen. The
floor of the canal was inspected on the right at both levels and on the left at
L4-5 and found to be free of any encroachment from disk protrusion or bulging.
At those 3 levels, the laminotomy and foraminotomies were simply performed to
decompress the canal and foramens. On the left at L5-S1, however, there was
noted to be foraminal and posterolateral subligamentous disk herniation, which
was removed through a cruciate annulotomy. Once it was felt the floor of the
canal and the foramen were patent and again, no encroachment on traversing or
exiting nerve root, decompression was felt to be complete. The only difference
again from all 4 foraminotomies was the left L5-S1 which was performed a
microdiskectomy. There was moderate amount of generalized bleeding which was
controlled with FloSeal and bipolar cautery; however, it was felt that as he had
4 foraminotomies the patient should stay overnight. Drain was placed for that
reason as well. The wound was then closed in layers and sterilely dressed.
Overall procedure was well tolerated. The patient was transferred to the
recovery room in stable condition.
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