amandaeholt
New
Please help! The codes I came up with are 22633, 22840, 20930. Any spinal coders want to advise?!
Procedure Performed:
EXTENSION OF PREVIOUS FUSION TO L23 W/ DECOMPRESSION /ALLOGRAFT
Procedure Findings:
After adequate general anesthesia was attained the patient was turned into a prone position on jelly rolls with the abdomen free and the back was prepped and draped in a sterile orthopedic manner. After infiltration of the subcutaneous tissue with 1 200,000 epinephrine a midline incision was made essentially reopening the prior midline incision. Skin and subcutaneous tissues were divided. Hemostasis was attained. The fascia was divided on each side of the midline proximally and distally and in the midline where the previous laminectomy had been performed. Dissection was initially continued out to the level of the instrumentation which could then be disassembled and removed. Next the dissection was continued to the tips of the transverse processes of L2 and L3. Combination of cautery curettes and rongeurs were then used to dissect the markedly degenerated facets at L2-3 and L3-4 from the scar and also dissect the lamina of L3 and the lamina of L4 from beneath the scar from the previous dissection. Attention was then directed to the decompression. Curette was used to identify the inferior edge of the 3 lamina which in essence was in direct contact with the upper edge of the 4 lamina. The facet joint spaces were identified with a narrow Leksell. The laminar bone at L3 was complete
Thinned with a rongeur and then Kerrisons were used to begin a laminectomy working from the inferior edge and send continuing completely through the L3 lamina up to the L2-3 interspace. The scar and ligamentous tissue were dissected from the upper edge of the 4 lamina and a Kerrison used to remove a few millimeters of bone from that edge. Working then in the lateral recess the majority of the inferior facet was removed as known from CT that the superior facet has was deformed essentially into the spinal canal it was separated from epidural scar and dura and the osteophyte along that edge were removed with a 3 Kerrison bilaterally. On the right further dissection under the anterior edge identified the 3 pedicle and the 3 root and a foraminotomies could be completed using the 3 Kerrison. On the left side however there was marked entrapment of the 3 root were essentially the pedicle of 3 was virtually in contact with the superior facet so curettes were used to define that edge most of the inferior facet was removed and dissection with a curette curette and then a 3 Kerrison to finely open the foramen so the ball-tipped pedicle feeler could be admitted with the 3 Road. Markers were then placed at the anatomic entry point of the pedicles of 2 and 3 and the C-arm was brought in position to confirm. At each position then the pedicle was entered with an awl on the left at L2 through a biopsy needle was used to aspirate 10 cc of blood and marrow for use and preparing allograft. At each position then the pilot hole was explored the depth determine tapped and the screw inserted based on the preoperative CT scan 5.5 screw was used at left L24.5 At right L2 and 6.5 bilateral at L3. The new screws were reinserted at L4 and on the left side at S1 as there was no L5 screw. On the right a screw was also inserted at L5. All screws had good purchase in the positions were checked with the C arm. The lateral gutters were then decorticated with a high-speed bur and the allograft was placed initially. All of the bone obtained from the decompression had been cleared of soft tissue morselized and then placed in the lateral gutters overlying the allograft. This was done bilaterally from L2-L4. Instrumentation was then assembled on the right side was tightened with a torque limiting wrench on the left side it was necessary to use an offset At L4 in order to align the that screw with the rod to the screws at S1 and L4 were tightened with a torque limiting wrench and slight distraction was applied between 3 and 4 where the 3 root had been so severely compressed. They removed the 3 and 2 screws were then tightened in with a torque wrench. Final x-ray showed good position of instrumentation and good alignment. The L3 screws were again checked with the ball-tipped pedicle feeler and both found to be completely free. The incision had been irrigated multiple times during the procedure with Irrisept irrigation. It was then closed over a HEENT Hemovac drain using 1 Vicryl 2-0 Vicryl and staples and dressed with Xeroform 4 x 4's and ABDs.
Procedure Performed:
EXTENSION OF PREVIOUS FUSION TO L23 W/ DECOMPRESSION /ALLOGRAFT
Procedure Findings:
After adequate general anesthesia was attained the patient was turned into a prone position on jelly rolls with the abdomen free and the back was prepped and draped in a sterile orthopedic manner. After infiltration of the subcutaneous tissue with 1 200,000 epinephrine a midline incision was made essentially reopening the prior midline incision. Skin and subcutaneous tissues were divided. Hemostasis was attained. The fascia was divided on each side of the midline proximally and distally and in the midline where the previous laminectomy had been performed. Dissection was initially continued out to the level of the instrumentation which could then be disassembled and removed. Next the dissection was continued to the tips of the transverse processes of L2 and L3. Combination of cautery curettes and rongeurs were then used to dissect the markedly degenerated facets at L2-3 and L3-4 from the scar and also dissect the lamina of L3 and the lamina of L4 from beneath the scar from the previous dissection. Attention was then directed to the decompression. Curette was used to identify the inferior edge of the 3 lamina which in essence was in direct contact with the upper edge of the 4 lamina. The facet joint spaces were identified with a narrow Leksell. The laminar bone at L3 was complete
Thinned with a rongeur and then Kerrisons were used to begin a laminectomy working from the inferior edge and send continuing completely through the L3 lamina up to the L2-3 interspace. The scar and ligamentous tissue were dissected from the upper edge of the 4 lamina and a Kerrison used to remove a few millimeters of bone from that edge. Working then in the lateral recess the majority of the inferior facet was removed as known from CT that the superior facet has was deformed essentially into the spinal canal it was separated from epidural scar and dura and the osteophyte along that edge were removed with a 3 Kerrison bilaterally. On the right further dissection under the anterior edge identified the 3 pedicle and the 3 root and a foraminotomies could be completed using the 3 Kerrison. On the left side however there was marked entrapment of the 3 root were essentially the pedicle of 3 was virtually in contact with the superior facet so curettes were used to define that edge most of the inferior facet was removed and dissection with a curette curette and then a 3 Kerrison to finely open the foramen so the ball-tipped pedicle feeler could be admitted with the 3 Road. Markers were then placed at the anatomic entry point of the pedicles of 2 and 3 and the C-arm was brought in position to confirm. At each position then the pedicle was entered with an awl on the left at L2 through a biopsy needle was used to aspirate 10 cc of blood and marrow for use and preparing allograft. At each position then the pilot hole was explored the depth determine tapped and the screw inserted based on the preoperative CT scan 5.5 screw was used at left L24.5 At right L2 and 6.5 bilateral at L3. The new screws were reinserted at L4 and on the left side at S1 as there was no L5 screw. On the right a screw was also inserted at L5. All screws had good purchase in the positions were checked with the C arm. The lateral gutters were then decorticated with a high-speed bur and the allograft was placed initially. All of the bone obtained from the decompression had been cleared of soft tissue morselized and then placed in the lateral gutters overlying the allograft. This was done bilaterally from L2-L4. Instrumentation was then assembled on the right side was tightened with a torque limiting wrench on the left side it was necessary to use an offset At L4 in order to align the that screw with the rod to the screws at S1 and L4 were tightened with a torque limiting wrench and slight distraction was applied between 3 and 4 where the 3 root had been so severely compressed. They removed the 3 and 2 screws were then tightened in with a torque wrench. Final x-ray showed good position of instrumentation and good alignment. The L3 screws were again checked with the ball-tipped pedicle feeler and both found to be completely free. The incision had been irrigated multiple times during the procedure with Irrisept irrigation. It was then closed over a HEENT Hemovac drain using 1 Vicryl 2-0 Vicryl and staples and dressed with Xeroform 4 x 4's and ABDs.