sandy321
New
Patient had a previous lumbar decompression,stabilization L2- S1 couple of yrs back.
Now
a) exploration of posterior spinal fusion L2 - S1 is done - 22830
b) removal of posterior hardware L2 - S1 (pedicle screws, rods and crosslinks) - 22852
c)augmentation of arthrodesis L2 - S1, 4 segments - ???
......
...... On exploration of fusion it was noticed that the patient had nice interfacetal fusion as well as over the spinous processes and lamina extending all the way from L2 to S1, No infection around the hardware. No loose screws or hardware. After crosslinks and rods were removed, the pedicle screws were taken out. Prior to taking out the pedicle screws, all the screws on the right side were tested. They all came in greater than 30 milliamps. After removing, copious irrigation was carried out. I then decorticated the top of the empty screw head, takedown the soft tissue and I was then able to withdraw close to 50 ml of bone marrow aspirate from a couple of pedicle screw holes using a Jamshidi needle. This was spun down to 10ml worth of stem cells, which was mixed with morsellized iliac crest allograft, DBM pure and DBM pure powder. This was layered and packed in the screw holes and on top of the previous fusion of the lateral gutters. After it was done, I used a PRP with thrombin for final hemostasis. .........
Will appreciate any help in coding this, please.
Now
a) exploration of posterior spinal fusion L2 - S1 is done - 22830
b) removal of posterior hardware L2 - S1 (pedicle screws, rods and crosslinks) - 22852
c)augmentation of arthrodesis L2 - S1, 4 segments - ???
......
...... On exploration of fusion it was noticed that the patient had nice interfacetal fusion as well as over the spinous processes and lamina extending all the way from L2 to S1, No infection around the hardware. No loose screws or hardware. After crosslinks and rods were removed, the pedicle screws were taken out. Prior to taking out the pedicle screws, all the screws on the right side were tested. They all came in greater than 30 milliamps. After removing, copious irrigation was carried out. I then decorticated the top of the empty screw head, takedown the soft tissue and I was then able to withdraw close to 50 ml of bone marrow aspirate from a couple of pedicle screw holes using a Jamshidi needle. This was spun down to 10ml worth of stem cells, which was mixed with morsellized iliac crest allograft, DBM pure and DBM pure powder. This was layered and packed in the screw holes and on top of the previous fusion of the lateral gutters. After it was done, I used a PRP with thrombin for final hemostasis. .........
Will appreciate any help in coding this, please.