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T12 Fracture

Brendan. Posted Fri 08th of June, 2012 03:43:39 AM

Please help with this op report. I'm thinking, but I'm new at NS: 22630, 22632, 22327-51, 22840, 62270-51, 20930

Patient fell of the monkey bars:

Postop Diagnosis: A T12 fracture dislocation

OPERATION PERFORMED:
1. Laminectomy, T11-12, for fracture dislocation or stenosis
2. Pedicle screw insertion, one level thoracic, T11, bilateral
3. Pedicle screw insertion, one level lumbar, L1, bilateral
4. ORIF, T12 Fracture
5. Lateral mass fusion, two levels, lumbar spine, T11-12, T12 and L1
6. Morselized allograft and locally harvested bone
7. Lumbar puncture for instillation of intrathecal narcotics

I am currently unable to post the op report. If need be I can do it with some Microsoft magic/luck, but I was hoping this would be enough.

Thank you,
Brendan

SuperCoder Answered Fri 08th of June, 2012 08:51:17 AM

We can understand the problem, but for several of the procedure it is really challenging to suggest the exact codes.
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Here I would like to share that the spinal fracture/fusion procedure has high RVU and the coding depends upon the instrumentation, approach, incision etc. As these are critical attributes in the spinal fusion/fixation coding we need detail op report to suggest you the exact code. It is suggested to be extra careful in the spinal fusion coding as a single word/approach can qualify for higher (lower) revenue.
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The Appropriate code for the given scenario (based upon the provided documentation) would be:

1. Laminectomy, T11-12, for fracture dislocation or stenosis – Would not be coded separately with most of the arthrodesis codes (62xxx -63xxx)

2. Pedicle screw insertion, one level thoracic, T11, bilateral – 22840 (need to look for fixation/ graft type/approach)

3.) Pedicle screw insertion, one level lumbar, L1, bilateral – 22840 (may qualify additionally if more than one interspaces is involved.)

4. ORIF, T12 Fracture – 22327-51 (good to go)

5. Lateral mass fusion, two levels, lumbar spine, T11-12, T12 and L1 (22630 & 22632 – subject to change depending upon the approach of fusion: complete op report is needed to suggest)

6. Morselized allograft and locally harvested bone – 22930 (another auto graft code may qualify if separate incision is made for grafting). If filling and or application of biomechanical cage/peek cage/allograft/bone paste is performed, 22851 may qualify additionally.

7. Lumbar puncture for instillation of intrathecal narcotics (62270 – diagnostic) (not be coded separately with above procedure).

Please note that the above code may change completely subject to the complete documentation.
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Hope this can assist.

Brendan. Posted Fri 08th of June, 2012 14:20:32 PM

Thank you. Here is the op report:

We created a linear skin incision from the spinous process of T10-L1, elevated soft tissue bilaterally, identified immediately hematoma in the paraspinous musculature at the T11-12 junction.

We then obtained serial x-ray, dissected down to the transverse process of L1, the tranverse process rib junction of T12 and T11.

There was an obvious rent in the interspoinous ligament at T11-12 with basing an auto laminectomy of T11-12 lamina by virtue of fracture. This was removed by laminectomy by a compination of hand and Midas Rex instrumentation. Underlying this was encountered epidural hematoma of roughly 4 mm in thickness. This was evacuated.

We then placed pedicle screws first on the left, then on the right at the T11 and L1, placing 6.5mmx 45mm lenght at L1, and 5.5 x 35 mm length at T11, again obtaining serial x-rays. Instrumentation was Nuvasive.

This was followed by application of pedicle screws in the right, same size and same location, each being Nuvasive, 6.5x45 at L1, and 5.5x35 at T11. We then affixed 8.5cm rods, pursued distraction for realignment, and obtained x-ray demonstrating anatomic reduction of the T12 fracture with good pedicle screw and rod placement.

There wa a lordotic rod used for assitance and realignment.

A this point, the construct was tightened down and crosslink applied.

Lumbar puncture was pursued with the 22-gauge needle at the L2-L3 level. Then, .20 mg of intrathecal morphine admininstered.

We then decorticated over the lateral masses of T11-12, and L1, laid a combination of bone morphogenic protein, morselized allograft, and locally harvested bone diffused from T11-12 to L1 bilaterally.

A 10mm Jackson-Pratt drain was then placed in the epidural space through a seperate stab wound, and the wound was closed in multiple layers with #1 Vicryl suture in the paravertebral muscle fascia and subcutaneous, with Dermabond on skin. Op-site was applied. The wound was infiltrated with 0.5% Marcaine with epinephrine. The patient returned to the recovery room in stable condition.

SuperCoder Answered Mon 11th of June, 2012 07:44:45 AM

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