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Post Operative Diagnosis: Pre-vertebral abscess, pseudorthrosis, and cervical stenosis
Procedure Performed: Anterior neck exploration with incision and drainage of abscess, revision of C4 corpectomy cage, and revision anterior cervical fusion, C3-C5
Indication for Procedure: This is a 50-year-old female with previously undergone anterior cervical fusion. She presented to the clinic with symptoms related to a prevertebral abscess, osteomyelitis, and pseudoarthrosis. She was brought to the operating room for incision and drainage of her abscess. She was identified to have a pseudoarthrosis of anterior cervical hardware. Hardware was removed and revised and found to have very poor bone quality, therefore she was brought to the operating room for further stabilization from C2 to C6.
Procedure in Detail: The patient was brought to the operating room and placed under general endotracheal anesthesia. She was positioned prone with the head in 3-point fixation using the radiolucent Mayfield. Neuro monitoring leads were placed. Foley catheter was placed. Pressure points were carefully padded. The neck was placed into neutral alignment. An incision was planned directly over the midline of the posterior cervical spine in order to approach the levels of interest. We performed a standard sterile prep and drape. Preoperative antibiotics were given. After formal time-out, the incision was made sharply. We brought this down through the fascia and performed a standard subperiosteal exposure of the posterior elements of C2 all the way down to C6 out to the lateral aspect of the lateral masses. At this point, the Medtronic O arm was brought into the room for an intraoperative CT scan for use of image guidance. CT scan was obtained. We verified the accuracy of our navigation under image guidance. C2 pedicle screws were planned bilaterally. The pedicles were cannulated, tapped and 4-0 diameter pedicle screws appropriately sized for length, were placed to cannulate the pedicles bilaterally at C2. Using external landmarks, we cannulated the lateral masses placing lateral mass screws into the lateral masses of C3, C4, C5, and C6 bilaterally, all with excellent fixation. At this point, rods were appropriately bent, sized, placed into our Tulip heads bilaterally and locked down with caps, which were subsequently final tightened. The posterior elements, facet joints, lateral masses were all decorticated in preparation for fusion. Graft consisting of allograft was placed and packed along the posterior elements and into the facet joints for fusion of C2 to C6. Final fluoroscopic images were obtained showing excellent placement of all hardware. At this point, the retractors were removed. We performed copious irrigation and performed standard layered closure over a drain. There were no complications.
I came up with CPTs: 22010; 22845-59; 69990-59; 22854; 20930. The insurance company is denying payment as there is no primary CPT code for 22845.
Post Operative Diagnosis: Pre-vertebral abscess, pseudorthrosis, and cervical stenosis
Procedure Performed: Anterior neck exploration with incision and drainage of abscess, revision of C4 corpectomy cage, and revision anterior cervical fusion, C3-C5
Indication for Procedure: This is a 50-year-old female with previously undergone anterior cervical fusion. She presented to the clinic with symptoms related to a prevertebral abscess, osteomyelitis, and pseudoarthrosis. She was brought to the operating room for incision and drainage of her abscess. She was identified to have a pseudoarthrosis of anterior cervical hardware. Hardware was removed and revised and found to have very poor bone quality, therefore she was brought to the operating room for further stabilization from C2 to C6.
Procedure in Detail: The patient was brought to the operating room and placed under general endotracheal anesthesia. She was positioned prone with the head in 3-point fixation using the radiolucent Mayfield. Neuro monitoring leads were placed. Foley catheter was placed. Pressure points were carefully padded. The neck was placed into neutral alignment. An incision was planned directly over the midline of the posterior cervical spine in order to approach the levels of interest. We performed a standard sterile prep and drape. Preoperative antibiotics were given. After formal time-out, the incision was made sharply. We brought this down through the fascia and performed a standard subperiosteal exposure of the posterior elements of C2 all the way down to C6 out to the lateral aspect of the lateral masses. At this point, the Medtronic O arm was brought into the room for an intraoperative CT scan for use of image guidance. CT scan was obtained. We verified the accuracy of our navigation under image guidance. C2 pedicle screws were planned bilaterally. The pedicles were cannulated, tapped and 4-0 diameter pedicle screws appropriately sized for length, were placed to cannulate the pedicles bilaterally at C2. Using external landmarks, we cannulated the lateral masses placing lateral mass screws into the lateral masses of C3, C4, C5, and C6 bilaterally, all with excellent fixation. At this point, rods were appropriately bent, sized, placed into our Tulip heads bilaterally and locked down with caps, which were subsequently final tightened. The posterior elements, facet joints, lateral masses were all decorticated in preparation for fusion. Graft consisting of allograft was placed and packed along the posterior elements and into the facet joints for fusion of C2 to C6. Final fluoroscopic images were obtained showing excellent placement of all hardware. At this point, the retractors were removed. We performed copious irrigation and performed standard layered closure over a drain. There were no complications.
I came up with CPTs: 22010; 22845-59; 69990-59; 22854; 20930. The insurance company is denying payment as there is no primary CPT code for 22845.