BFAITHFUL
Expert
Doc wants to use CPT's 63047, 63030, 20926, 69990 and 22899 for On-Q catheter but not sure about these codes?
Thanks
DX: L5-S1 herniated disc & lumbar radiculopathy
After previously obtaining informed consent and discussion of possible risks, benefits and alternatives of the procedure in a detailed way and after having made no guarantees in any way, the patient was brought to the operating room on a stretcher at which time general endotracheal anesthesia was induced without complications. Two grams of Ancef and 10 mg of Decadron intravenous solutions were then infused. The patient was then turned over onto the Wilson frame of the operating table in the prone position. The patient's low back was then prepped and draped in the usual sterile fashion. After first infiltrating with local anesthesia, a midline skin incision approximately one inch in length was made extending over the L5 spinous process. The incision was carried down through the subcutaneous tissue and fat to the lumbar fascia which was incised along the right side of the spinous process. The deep paraspinal musculature on that side was then elevated in a subperiosteal type fashion and retained laterally. A localizing fluoroscopic x-ray was then obtained. After first elevating the yellowing ligament from the undersurface of the L5 lamina, a near complete right L5 hemilaminectomy was completed. The yellow ligament was removed in a similar fashion without any injury to the underlying dura or neural elements. A right L5 medial facetectomy and foraminotomy was then completed. The microscope was then brought into the operative field to help aid in microdissection and to help with the discectomy. The right side of the thecal sac and the S1 nerve root were identified and found to be displaced posteriorly. With gentle retraction of the nerve root medially, a central and right paracentral disc herniation was identified. An annulotomy was made and the herniated portions of the disc were carefully removed. An internal discectomy was also completed and the nerve root and thecal sac were then fully decompressed and fully mobile. The localizing fluoroscopic x-ray was then obtained and saved, which I personally supervised and interpreted as identifying a surgical instrument in the L5-S1 disc space.
A small subcutaneous fat graft was then harvested and placed along the S1 nerve root. After obtaining meticulous hemostasis and after copious irrigation of the surgical cavity using 3 liters of Neosporin antibiotic solution, the lumbar fascia was reapproximated using interrupted figure-of-eight 1 Vicryl sutures. The subcutaneous tissues were reapproximated using inverted interrupted 2-0 Vicryl sutures and the skin was closed using staples.
The wound was then washed and a 2.5 inch On-Q local anesthetic catheter was then placed on the right side at an entry point approximately two inches superiorly and laterally to the incision within the subcutaneous fat. The On-Q pain pump was filled with 0.375% Marcaine and no bolus dose was given. The On-Q catheter was secured to the patient's skin using Steri-Strips and a clean sterile dressing was applied
Thanks
DX: L5-S1 herniated disc & lumbar radiculopathy
After previously obtaining informed consent and discussion of possible risks, benefits and alternatives of the procedure in a detailed way and after having made no guarantees in any way, the patient was brought to the operating room on a stretcher at which time general endotracheal anesthesia was induced without complications. Two grams of Ancef and 10 mg of Decadron intravenous solutions were then infused. The patient was then turned over onto the Wilson frame of the operating table in the prone position. The patient's low back was then prepped and draped in the usual sterile fashion. After first infiltrating with local anesthesia, a midline skin incision approximately one inch in length was made extending over the L5 spinous process. The incision was carried down through the subcutaneous tissue and fat to the lumbar fascia which was incised along the right side of the spinous process. The deep paraspinal musculature on that side was then elevated in a subperiosteal type fashion and retained laterally. A localizing fluoroscopic x-ray was then obtained. After first elevating the yellowing ligament from the undersurface of the L5 lamina, a near complete right L5 hemilaminectomy was completed. The yellow ligament was removed in a similar fashion without any injury to the underlying dura or neural elements. A right L5 medial facetectomy and foraminotomy was then completed. The microscope was then brought into the operative field to help aid in microdissection and to help with the discectomy. The right side of the thecal sac and the S1 nerve root were identified and found to be displaced posteriorly. With gentle retraction of the nerve root medially, a central and right paracentral disc herniation was identified. An annulotomy was made and the herniated portions of the disc were carefully removed. An internal discectomy was also completed and the nerve root and thecal sac were then fully decompressed and fully mobile. The localizing fluoroscopic x-ray was then obtained and saved, which I personally supervised and interpreted as identifying a surgical instrument in the L5-S1 disc space.
A small subcutaneous fat graft was then harvested and placed along the S1 nerve root. After obtaining meticulous hemostasis and after copious irrigation of the surgical cavity using 3 liters of Neosporin antibiotic solution, the lumbar fascia was reapproximated using interrupted figure-of-eight 1 Vicryl sutures. The subcutaneous tissues were reapproximated using inverted interrupted 2-0 Vicryl sutures and the skin was closed using staples.
The wound was then washed and a 2.5 inch On-Q local anesthetic catheter was then placed on the right side at an entry point approximately two inches superiorly and laterally to the incision within the subcutaneous fat. The On-Q pain pump was filled with 0.375% Marcaine and no bolus dose was given. The On-Q catheter was secured to the patient's skin using Steri-Strips and a clean sterile dressing was applied
