Here is a 2 level ACDF w/seperate incisions made at each level. OP Report is below:
PROCEDURES PERFORMED:
1. Reexploration of anterior cervical incision with lysis of scar x 2.
2. Anterior cervical discectomy and arthrodesis of C3-4.
3. Placement of Zimmer Spine Stalif-C PEEK interbody device supplemented by Puros DBM allograft at C3-4.
2. Anterior cervical discectomy and arthrodesis of C6-7 through a separate incision.
3. Placement of Zimmer Spine Stalif-C PEEK interbody device supplemented by Puros DBM allograft at C6-7.
ANESTHESIA: General
INDICATIONS FOR SURGERY: The patient is a 56 Year Old woman with neck and arm pain. Her symptoms failed to respond to conservative intervention. An MRI scan was performed and this showed evidence cervical stenosis and disc herniation at both C3-4 and C6-7. She had a previous anterior discectomy and fusion of C4-6 with anterior cervical plating. Having failed conservative management and experiencing persistent symptoms, the patient elected to proceed with anterior cervical discectomy with stabilization and fusion at C3-4 and C6-7. We discussed several options for approaching this and she chose to proceed with the Stalif C device. I did explain that I had some concerns regarding the stress on these devices. She signed consent and wished to proceed.
DETAILS OF PROCEDURE: The patient's name, procedure to be done, and location of the problem were verified in my standard fashion. The patient was brought to the operating room and placed under general anesthesia. She was then placed supine on the operating table. The C-arm was used to verify the location of the incision. The anterior cervical area was prepped and draped in the usual sterile fashion and the C-arm was draped into the field as well. Using a #15 blade knife, the skin was incised in a horizontal fashion over the C3-4 disc space. The platysma was elevated and opened in transverse fashion and dissected free from underlying tissues. I immediately encountered scar tissue. After carefully dissecting through the scar I was able to safely mobilize the carotid artery laterally while mobilizing and protecting the esophagus medially. The superior aspect of the plate was identified and separated from overlying scar. the longus colli muscles were mobilized and the retractor placed. Two 12mm caspar pins were then placed with fluoroscopic verification of their location into the C3 and C4 vertebral body over the anterior cervical plate. The pin distracter was then used to apply gentle retraction on the disc space. The disc was then further incised and removed using the curette, pituitary rongeur and the high-speed Midas Rex drill. The posterior longitudinal ligament was opened and removed and the foramen were opened bilaterally. There was significant compression of the thecal sac from a large disc herniation. Once the decompression was complete the wound was copiously irrigated with antibiotic solution as it had been throughout the case. The cartilaginous endplates were removed and the bone was squared off in preparation for the graft. After measuring the space a 7.5mm lordotic Stalif C PEEK graft was placed after first packing it with DBM allograft. The awe was used to create an opening for the inferior midline screw. A 14 mm screw was placed without difficulty. I then repeated this superiorly for the two superior screws. All screws had good purchase and were 14mm in length. I then partially closed the incision after first copiously irrigating with antibiotic solution and ensuring hemostasis.
A separate right sided transverse incision was then made over the C6-7 disc space. The dissection was similar after elevating the platysma. There was scar at this level as well. The inferior aspect of the plate was identified and separated from overlying scar. the longus colli muscles were mobilized and the retractor placed. Two 12mm caspar pins were then placed with fluoroscopic verification of their location into the C6 and C7. The pin distracter was then used to apply gentle retraction on the disc space. The disc was then further incised and removed using the curette, pituitary rongeur and the high-speed Midas Rex drill. The posterior longitudinal ligament was opened and removed and the foramen were opened bilaterally. A large right sided extruded disc fragment was identified and removed. Once the decompression was complete the wound was copiously irrigated with antibiotic solution as it had been throughout the case. The cartilaginous endplates were removed and the bone was squared off in preparation for the graft. After measuring the space an 8.5mm lordotic Stalif C PEEK graft was placed after first packing it with DBM allograft. The awe was used to create an opening for the superior midline screw. A 16mm screw was placed without difficulty. I then repeated this superiorly for the two inferior screws. All screws had good purchase and were 16mm in length. The wound was inspected for hemostasis and then closed in the usual fashion using interrupted 3-0 Vicryl in the platysma and a running 4-0 Monocryl in the subcuticular layer. A sterile dressing was then applied. The superior wound was then closed in the same fashion. The patient was extubated in the operating room and transferred to the recovery room in stable condition. There were no complications. The blood loss was minimal.
My question is this, can I not code using the following codes:
22551, 22551-59 (for seperate incision), 22845, 22851, 22851-59, 20930
Or is it best to use the 22552 for the additional level? My thought was that there was a different, seperate incision clearly stated. I could add the -59 modifier and get a higher reimbursement. Any insight would be helpful
PROCEDURES PERFORMED:
1. Reexploration of anterior cervical incision with lysis of scar x 2.
2. Anterior cervical discectomy and arthrodesis of C3-4.
3. Placement of Zimmer Spine Stalif-C PEEK interbody device supplemented by Puros DBM allograft at C3-4.
2. Anterior cervical discectomy and arthrodesis of C6-7 through a separate incision.
3. Placement of Zimmer Spine Stalif-C PEEK interbody device supplemented by Puros DBM allograft at C6-7.
ANESTHESIA: General
INDICATIONS FOR SURGERY: The patient is a 56 Year Old woman with neck and arm pain. Her symptoms failed to respond to conservative intervention. An MRI scan was performed and this showed evidence cervical stenosis and disc herniation at both C3-4 and C6-7. She had a previous anterior discectomy and fusion of C4-6 with anterior cervical plating. Having failed conservative management and experiencing persistent symptoms, the patient elected to proceed with anterior cervical discectomy with stabilization and fusion at C3-4 and C6-7. We discussed several options for approaching this and she chose to proceed with the Stalif C device. I did explain that I had some concerns regarding the stress on these devices. She signed consent and wished to proceed.
DETAILS OF PROCEDURE: The patient's name, procedure to be done, and location of the problem were verified in my standard fashion. The patient was brought to the operating room and placed under general anesthesia. She was then placed supine on the operating table. The C-arm was used to verify the location of the incision. The anterior cervical area was prepped and draped in the usual sterile fashion and the C-arm was draped into the field as well. Using a #15 blade knife, the skin was incised in a horizontal fashion over the C3-4 disc space. The platysma was elevated and opened in transverse fashion and dissected free from underlying tissues. I immediately encountered scar tissue. After carefully dissecting through the scar I was able to safely mobilize the carotid artery laterally while mobilizing and protecting the esophagus medially. The superior aspect of the plate was identified and separated from overlying scar. the longus colli muscles were mobilized and the retractor placed. Two 12mm caspar pins were then placed with fluoroscopic verification of their location into the C3 and C4 vertebral body over the anterior cervical plate. The pin distracter was then used to apply gentle retraction on the disc space. The disc was then further incised and removed using the curette, pituitary rongeur and the high-speed Midas Rex drill. The posterior longitudinal ligament was opened and removed and the foramen were opened bilaterally. There was significant compression of the thecal sac from a large disc herniation. Once the decompression was complete the wound was copiously irrigated with antibiotic solution as it had been throughout the case. The cartilaginous endplates were removed and the bone was squared off in preparation for the graft. After measuring the space a 7.5mm lordotic Stalif C PEEK graft was placed after first packing it with DBM allograft. The awe was used to create an opening for the inferior midline screw. A 14 mm screw was placed without difficulty. I then repeated this superiorly for the two superior screws. All screws had good purchase and were 14mm in length. I then partially closed the incision after first copiously irrigating with antibiotic solution and ensuring hemostasis.
A separate right sided transverse incision was then made over the C6-7 disc space. The dissection was similar after elevating the platysma. There was scar at this level as well. The inferior aspect of the plate was identified and separated from overlying scar. the longus colli muscles were mobilized and the retractor placed. Two 12mm caspar pins were then placed with fluoroscopic verification of their location into the C6 and C7. The pin distracter was then used to apply gentle retraction on the disc space. The disc was then further incised and removed using the curette, pituitary rongeur and the high-speed Midas Rex drill. The posterior longitudinal ligament was opened and removed and the foramen were opened bilaterally. A large right sided extruded disc fragment was identified and removed. Once the decompression was complete the wound was copiously irrigated with antibiotic solution as it had been throughout the case. The cartilaginous endplates were removed and the bone was squared off in preparation for the graft. After measuring the space an 8.5mm lordotic Stalif C PEEK graft was placed after first packing it with DBM allograft. The awe was used to create an opening for the superior midline screw. A 16mm screw was placed without difficulty. I then repeated this superiorly for the two inferior screws. All screws had good purchase and were 16mm in length. The wound was inspected for hemostasis and then closed in the usual fashion using interrupted 3-0 Vicryl in the platysma and a running 4-0 Monocryl in the subcuticular layer. A sterile dressing was then applied. The superior wound was then closed in the same fashion. The patient was extubated in the operating room and transferred to the recovery room in stable condition. There were no complications. The blood loss was minimal.
My question is this, can I not code using the following codes:
22551, 22551-59 (for seperate incision), 22845, 22851, 22851-59, 20930
Or is it best to use the 22552 for the additional level? My thought was that there was a different, seperate incision clearly stated. I could add the -59 modifier and get a higher reimbursement. Any insight would be helpful