joanne71178
Guru
Would the correct code be 63267? or 63030? Thanks in advance! I'm stumped. 
Diagnosis: 1. Sever Spinal Stenosis L2-3 ( 724.02)
2. Extra dual mass L2-3 (727.40)
Procedure:
"A midline incision was made between L2 and L3, carried down to the interlaminar space to the right of midline at that level. X-ray was obtained which confirmed our position. High speed bur was used to remove the inferior aspect of t he L2 lamina along with the medial aspect of both L2-3 facet joints out to the medial wall of L3 pedicles bilaterally. Ligamentum flavum was then carefully removed in a piecemeal fashion.
A large extradural mass was noted essentially in to the right and left of the midline, and it was adhesed to the dura. This was carefully teased from the dural and removed without difficulty. It was excellent de compression of the dural sac and both L3 nerve roots. The entire decompression was carried out using the operating microscope. "
Diagnosis: 1. Sever Spinal Stenosis L2-3 ( 724.02)
2. Extra dual mass L2-3 (727.40)
Procedure:
"A midline incision was made between L2 and L3, carried down to the interlaminar space to the right of midline at that level. X-ray was obtained which confirmed our position. High speed bur was used to remove the inferior aspect of t he L2 lamina along with the medial aspect of both L2-3 facet joints out to the medial wall of L3 pedicles bilaterally. Ligamentum flavum was then carefully removed in a piecemeal fashion.
A large extradural mass was noted essentially in to the right and left of the midline, and it was adhesed to the dura. This was carefully teased from the dural and removed without difficulty. It was excellent de compression of the dural sac and both L3 nerve roots. The entire decompression was carried out using the operating microscope. "