RebeccaWoodward*
True Blue
There is difference of opinion on how this needs to be coded......
A midline incision was made and carried down to the lumbodorsal fascia. Bipolar cautery was used for hemostatis. The fascia was opened on both sides of midline. Fluro was again brought into use to confirm the levels. The paraspinal muscles were reflected laterally, bilaterally. A self retaining retractor was inserted. The operating microscope was brought into use. Partial hemilaminectomies were created at L3-4 and L4-5 on the left using high speed drill and Kerrison rongeurs. The underlying ligamentum flavum was removed. The exiting left L4 and L5 nerve roots were identified and carefully preserved. Foraminotomies were performed were performed at both levels using Kerrison rongeurs. A blunt nerve hook was then inserted anterior to the thecal sac and the L3-4 and L4-5 disk spaces were palpated. There is no evidence of ruptured disk at L4-5. However, at the L3-4 level multiple free fragments of disk were identified which had migrated inferiorly along the posterior aspect of L4 body. They were mobilized using a blunk hook and removed using a pituitary rongeur. The L4 nerve root then became more mobile and was able to be mobilized medially. Patties were placed in the epidural space for gentl medial retraction. The annulus was opened with a number 11 blade. The diskectomy was performed using curettes and pituitary rongeurs. The disk space was then flushed several times with antibiotic irrigation. Further exploration revealed no more free fragments of disk. The patties were removed. The blunt nerve hook was used to explore anterior to the thecal sac and anterior to the left L4 nerve root. No further evidence of disk ruptured or nerve root compression was found. Final hemostasis on both sides was secured using bipolar cautery, surgical, gelfoam and bone wax. The left side was then packed and attention was turned to the right side.
Rt L3-4 and L4-5 parital hemilaminectomies were created using the high speed drill and Kerrison rongeurs. The underlying ligamentum flavum was removed. The exiting right L4 and L5 nerve roots were identified and carfefully preserved. Foraminotomies were performed and both levels with Kerrison rongeurs. A blunt nerve hook was inserted anterior to the thecal sac at both levels, and both disk spaces were palpated. There was no evidence of ruptured disk. Final hemostasis on both sides was secured using bipolar cautery, surgical, gelfoam and bone wax.
My recommendation was 63030-50 and 63035-50
The physicians charge ticket reflects 63030 63030-50 and 63047 . I just can't wrap my head around this!!
My reasoning for 63030-50 and 63035-50 is that a partial foraminotomy is included in the 63030. Even though the op notes states “Foraminotomy” was performed, the other available codes would require more work than what was reported. Example-63047: This would necessitate a laminectomy, foraminotomy AND a facetectomy to qualify. Or so...in my opinion.
A midline incision was made and carried down to the lumbodorsal fascia. Bipolar cautery was used for hemostatis. The fascia was opened on both sides of midline. Fluro was again brought into use to confirm the levels. The paraspinal muscles were reflected laterally, bilaterally. A self retaining retractor was inserted. The operating microscope was brought into use. Partial hemilaminectomies were created at L3-4 and L4-5 on the left using high speed drill and Kerrison rongeurs. The underlying ligamentum flavum was removed. The exiting left L4 and L5 nerve roots were identified and carefully preserved. Foraminotomies were performed were performed at both levels using Kerrison rongeurs. A blunt nerve hook was then inserted anterior to the thecal sac and the L3-4 and L4-5 disk spaces were palpated. There is no evidence of ruptured disk at L4-5. However, at the L3-4 level multiple free fragments of disk were identified which had migrated inferiorly along the posterior aspect of L4 body. They were mobilized using a blunk hook and removed using a pituitary rongeur. The L4 nerve root then became more mobile and was able to be mobilized medially. Patties were placed in the epidural space for gentl medial retraction. The annulus was opened with a number 11 blade. The diskectomy was performed using curettes and pituitary rongeurs. The disk space was then flushed several times with antibiotic irrigation. Further exploration revealed no more free fragments of disk. The patties were removed. The blunt nerve hook was used to explore anterior to the thecal sac and anterior to the left L4 nerve root. No further evidence of disk ruptured or nerve root compression was found. Final hemostasis on both sides was secured using bipolar cautery, surgical, gelfoam and bone wax. The left side was then packed and attention was turned to the right side.
Rt L3-4 and L4-5 parital hemilaminectomies were created using the high speed drill and Kerrison rongeurs. The underlying ligamentum flavum was removed. The exiting right L4 and L5 nerve roots were identified and carfefully preserved. Foraminotomies were performed and both levels with Kerrison rongeurs. A blunt nerve hook was inserted anterior to the thecal sac at both levels, and both disk spaces were palpated. There was no evidence of ruptured disk. Final hemostasis on both sides was secured using bipolar cautery, surgical, gelfoam and bone wax.
My recommendation was 63030-50 and 63035-50
The physicians charge ticket reflects 63030 63030-50 and 63047 . I just can't wrap my head around this!!
My reasoning for 63030-50 and 63035-50 is that a partial foraminotomy is included in the 63030. Even though the op notes states “Foraminotomy” was performed, the other available codes would require more work than what was reported. Example-63047: This would necessitate a laminectomy, foraminotomy AND a facetectomy to qualify. Or so...in my opinion.
I knew the other scenario couldn't be plausible.