betsycpcp
Networker
I've never run across one quite like this before- the pre and post op dx is "delayed union L3-4 anterior interbody fusion through a transosseous approach." The procedure is listed as "segmental spinal instrumentation L3-4. Intraoperative interpretation EMG by surgeon."
Here's the description:
After satisfactory anesthesia was obtained with the patient on the Jackson table, the back was prepped and draped in usual sterile fashion. We made incisions bilaterally exposing the L3 and L4 facet joints bilaterally. Under fluoroscopic guidance, we placed the Jamshidi needle into the pedicle followed by Nitinol wire, followed by a tap, followed by placement of our screws. We used 5.5 screws proximally and 6.5 mm screws distally. We confirmed its position with our C-arm. We stimulated the screws to ensure that the estimated appropriate thresholds. We then placed our 5.5 mm rod into place. This was 45 mm in length. It was locked into place using our set screws torqued to the appropriate torque setting. The instruments were removed and wounds were closed with subcuticular closure. A compression dressing was placed. The patient tolerated the procedure well and was returned to the recovery room in satisfactory condition.
I work for the payer. The provider billed 63030 (Laminotomy (hemilaminectomy), w/ decompression incl partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc)
, 22842 (Posterior segmental instrumentation 3 to 6 vertebral segments) and 20936 (local autograft). I have no idea where they're getting 63030 or 20936, but since 22842 is an add-on code I know it can't be billed by itself. Any ideas how this should be coded?
Here's the description:
After satisfactory anesthesia was obtained with the patient on the Jackson table, the back was prepped and draped in usual sterile fashion. We made incisions bilaterally exposing the L3 and L4 facet joints bilaterally. Under fluoroscopic guidance, we placed the Jamshidi needle into the pedicle followed by Nitinol wire, followed by a tap, followed by placement of our screws. We used 5.5 screws proximally and 6.5 mm screws distally. We confirmed its position with our C-arm. We stimulated the screws to ensure that the estimated appropriate thresholds. We then placed our 5.5 mm rod into place. This was 45 mm in length. It was locked into place using our set screws torqued to the appropriate torque setting. The instruments were removed and wounds were closed with subcuticular closure. A compression dressing was placed. The patient tolerated the procedure well and was returned to the recovery room in satisfactory condition.
I work for the payer. The provider billed 63030 (Laminotomy (hemilaminectomy), w/ decompression incl partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc)
, 22842 (Posterior segmental instrumentation 3 to 6 vertebral segments) and 20936 (local autograft). I have no idea where they're getting 63030 or 20936, but since 22842 is an add-on code I know it can't be billed by itself. Any ideas how this should be coded?