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Posterior Laminar Fusion

Charles Posted Tue 06th of March, 2012 03:23:50 AM

Need assistance in coding: Posterior laminar fusion with OP-1BMP putty and stabilization with posterior instrumentation T12-L2.

After patient was anesthetized and intubated, she awas placed in the prone position on the 4 post Jackson table. The mid back was prepped and draped in the usual manner. Midline vertical incision was marked on the skin extending from T11 down to just below the L2-L3 interlaminar space. Skin was infiltrated with local anesthetic. The skin was infiltrated with local anesthetic and incision made sharply down to the deep fascia. Deep fascia was divided on either side of the midline, extended over the respective spinous processes and lamina of T12 down to L2. Paraspinous muscles were retracted apart. Then under fluroscopic guidance, pedicle screws were inserted trans_____into the veterbral body of T12 and L2 and no screws were inserted in L1 because the previous corpectomy had been done. Then the bow at the spinal laminar junection at T12, L1 and L2 were carefully decorticated in preparation for infralaminar fusion. Then, a cylinder of OP-1 putty was laid along the spinal laminar line from T2 down to L2. The wound had been irrigated with copious amounts of antibotic normal saline solution right before that and before the OP-1 putty was laid in place. Then, all bleeding was controlled. The would was then closed in layers. A sterile occlusive dressing was applied. No complications were encountered. Patient tolerated the procedure without difficulty. The insertion of the pedicle screws and rods were carried out under flourscopic guidance. Care was taken to make certain that intraoperative electrodiagnostic testing showed that the pedicle screws were in good position and not too close to the exiting nerve root. The patient tolerated the procedure without difficulty and was taken immediately to the recovery room, extubated and awake.

SuperCoder Answered Tue 06th of March, 2012 08:27:11 AM

As arthrodesis (fusion) and stabilization with instrumentation has been done in three vertebral body, thoracic (T12) and two lumbars (L1-L2), you are eligible to code all three, as per above scenario. But as per latest CCI edits version 18.0, CPT 22612 (higher RVU 47.14) bundles code 22610 (lower RVU 37.12) and you could override the edits by appending modifier -59. So, you could bill in this way:
22612--For single lumbar level
22610-59--For single thoracic level
22614--For additional lumbar level

Charles Posted Tue 06th of March, 2012 18:44:09 PM

Thank you very much.

Constance Answered Thu 12th of April, 2012 20:23:31 PM

i would do 22612, 22614x2 accaording to AANS when you cross levels you just add the additional level code except for 22590 and 22595

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