Wiki Posterior Segmental Fusion - Need a little help.

bailsb

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In need of someone to review my codes :)

I believe I see: 22610 - Arthrodesis, posterior or posterolateral technique, single level; thoracic
22614 x 2 - Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (list separately in addition to code for primary procedure)
22843 - Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (list separately in addition to ...)

:)

Postop diagnosis: Osteomyelitis of the T10, T11, T12

Posterior segmental fusion in T3, T4, T5, T6, T7, T8, T9 and L1, L2, L3 with pedicle screw from Synthes and posterolateral fusion from T9-L1. The patient went to the CAT scan and CAT scan of the thoracolumbar spine was done extensively with BrainLab protocol. Afer the patient was brought to the operating room, Brainlab was used aggressively intensively. Then Pedicle screw applied from T3 to L3 with use of BrainLab pointer.

The patient was previously operated on in Mexico. Apparently, the patient had laminotomy done. The patient presenting with increasing pain. Osteo of the T10, T11, T12 with destruction of the body. The patient brought for segmental fusion posteriorly for the first stage process. Two stage operation because she had lesion in the lower lumbar spine L2-L5.

After patient was brought to the operating room and placed under appropriate general endotracheal anesthesia. Thoracolumbar spine widely prepped and draped. An incision was marked between spinous process from T2 to L4-L5. Thoracolumbar incision opened. Thoracolumbar fascia opened in line. Then corresponding muscle was elevated from T2-L4 bilaterally. Then tranverse process of the T3, T4, T5, T6, T7, T8 and T9 exposed. Also dissection L1, L2, L3 exposed. The patient previous laminotomy at the level of T10, T11, T12 and kyphotic deformity.
First using the wires, the registration point was attached to the spinous process of T10. The patient was registered, pedicle screw applied T3, T4, T5, T6, T7, T8, and T9 bilaterally. At the T3, T4, T5 5.0 and 30, at the level of the T6, T7, T9, T10 used 5.5 and 40.
Registration form attached to the body of L3. Patient was again registered and pedicle screw applied at the L1, L2, L3 6.5 and 5.0 in usual fashion.
The rod brought to the field. Applied to the head of the pedicle screw from the T3 through L3 and then one cross link applied and locked it. Posterolateral fusion was done between T10, T11, T12, L2. Fascia closed with 1-0 Ethibond, subcu with 2-0 Vicryl, skin with staples.

Thank you,
Brendan, CPC
 
Your codes look good to me. However, I am very curious as to what your op report means by registration. it's said several times and I have no idea. I have asked several coders what you mean by that and they also don't know.

can you fill me in?

"Registration form attached to the body of L3"
"The patient was registered, pedicle screw applied T3, T4, T5, T6, T7, T8, and T9 bilaterally"
First using the wires, the registration point was attached to the spinous process of T10.
 
Hi Christopher,

I appreciate you reviewing this op note. Yes, I am scratching my head about what the surgeon means by the word "registered" and "registration". I spent a good amount of time on Google trying to figure that one out. I'm assuming he means attaching the instrumentation to the screws, but I should probably have a discussion with him or one of his staff to clarify. Thank you again.
 
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