jholloway2
Guest
We have a spine surgeon that does the ADR in the ASC. I am knew to the spine world of coding for the ASC side. Can some one tell me if am allowed to bill the 76000,59,TC (flouro with the 22856, 22858, C1889) and should I be billing the 22845( instrumentation) or if this is bundled in the 22856. Any help would be greatly appreciated.
Procedure: artificial disc replacement C4-6 versus anterior
cervical discectomy and fusion C4-6 with PEEK cage,
autograft/ allograft, anterior cervical plate
1. Pre-operative Diagnosis: C4-6 disc herniations
2. Post-operative Diagnosis: same
3. Procedure: artificial disc replacement at C4-5 , and C5-6 using LDR Mobi-C implants
4. Anesthesia: general endotracheal
5. Assistant: yes
6. Complications: none
The patient was identified by name and name plate. The patient was placed under general anesthesia by the
anesthesia team without incident. A broad spectrum IV antibiotic was given. The patient was placed into the
supine position on the radiolucent table. A roll was placed between the shoulder blades, and the shoulders were
gently taped downward in order to allow for cross table lateral visualization. The neck and left anterior iliac crest
were prepped and draped in a sterile fashion. A transverse incision was made on the left side of the neck
overlying the C 5 vertebral body. The platysma was divided vertically and then the potential space between the
sternocleidomastoid and carotid sheath contents laterally, and the trachea, esophagus and strap muscles medially
was exploited. The prevertebral and pretracheal fascia were incised. A spine marker was taken and confirmed to
be at the appropriate disc level. The longus colli muscles were elevated at the level of the disc and retractors were
placed underneath this. Distraction was placed across the disc space. A subtotal discectomy was performed back
to the posterior longitudinal ligament. The posterior longitudinal ligament was then taken down with a 1 mm
Kerrison punch. The endplates were denuded of any overlying cartilage. Trialing was performed and the
appropriate sized LDR Mobi-C implant was chosen and loaded onto the jig and inserted into the C5-6 disc space.
The implant was noted be in good position on AP and lateral fluoroscopic views. Compression was placed across
the disc space in order to seat the implant. The jig was then removed. This procedure was repeated at the C4-5
disc. Once the implant was placed at the C 4-5 disc then the undersurface of the esophagus was inspected and
noted to be free of any trauma. A drain was laid over the vertebral bodies and brought out through a separate
fascial incision. All retractors were removed. There was noted to be no significant bleeding within the wound.
The platysma was repaired with a running Vicryl suture. The skin edges were approximated with Monocryl
suture. Sterile dressings were applied.
Thank You,
JTH
jillh5826@gmail.com
Procedure: artificial disc replacement C4-6 versus anterior
cervical discectomy and fusion C4-6 with PEEK cage,
autograft/ allograft, anterior cervical plate
1. Pre-operative Diagnosis: C4-6 disc herniations
2. Post-operative Diagnosis: same
3. Procedure: artificial disc replacement at C4-5 , and C5-6 using LDR Mobi-C implants
4. Anesthesia: general endotracheal
5. Assistant: yes
6. Complications: none
The patient was identified by name and name plate. The patient was placed under general anesthesia by the
anesthesia team without incident. A broad spectrum IV antibiotic was given. The patient was placed into the
supine position on the radiolucent table. A roll was placed between the shoulder blades, and the shoulders were
gently taped downward in order to allow for cross table lateral visualization. The neck and left anterior iliac crest
were prepped and draped in a sterile fashion. A transverse incision was made on the left side of the neck
overlying the C 5 vertebral body. The platysma was divided vertically and then the potential space between the
sternocleidomastoid and carotid sheath contents laterally, and the trachea, esophagus and strap muscles medially
was exploited. The prevertebral and pretracheal fascia were incised. A spine marker was taken and confirmed to
be at the appropriate disc level. The longus colli muscles were elevated at the level of the disc and retractors were
placed underneath this. Distraction was placed across the disc space. A subtotal discectomy was performed back
to the posterior longitudinal ligament. The posterior longitudinal ligament was then taken down with a 1 mm
Kerrison punch. The endplates were denuded of any overlying cartilage. Trialing was performed and the
appropriate sized LDR Mobi-C implant was chosen and loaded onto the jig and inserted into the C5-6 disc space.
The implant was noted be in good position on AP and lateral fluoroscopic views. Compression was placed across
the disc space in order to seat the implant. The jig was then removed. This procedure was repeated at the C4-5
disc. Once the implant was placed at the C 4-5 disc then the undersurface of the esophagus was inspected and
noted to be free of any trauma. A drain was laid over the vertebral bodies and brought out through a separate
fascial incision. All retractors were removed. There was noted to be no significant bleeding within the wound.
The platysma was repaired with a running Vicryl suture. The skin edges were approximated with Monocryl
suture. Sterile dressings were applied.
Thank You,
JTH
jillh5826@gmail.com