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Lumbar Spine diskectomy reexploration

I only code a couple spine surgeries a year, so sort of at a loss here. Any help is appreciated. The patient had a previous LEFT sided L5-S1 Diskectomy with laminotomy and foraminotomy for HNP L5-S1.
A year later, he now had a "Repeat discectomy left sided L5-S1 with foraminotomy and laminotomy. Lysis of adhesions. " AND RIGHT Sided diskectomy with laminotomy and foraminotomy. The OP note is hard to read, with many transcription errors (that will need to be fixed). But bascially, all that was done on the LEFT side was lysis of adhesions. Here’s that portion of the OP Note:

"Scar tissue present was removed. The dura was visualized above and below previous surgical site. Some adhesion between the nerve roots was also identified and released. Feel adequate safe interval to perform the discectomy through the scar tissue therefore attention was turned to the right side."

Is this enough for 63042 ? I can’t tell if a laminotomy and/or foramintomy was actually done. Diskectomy wasn’t done.

The RIGHT side looks like a straightforward laminotomy with diskectomy – 63030. It’s the "repeat" procedure I’m stuck on.

Thanks,
Cindy

Medical Billing and Coding Forum

HCC question on Facet Arthritis of lumbar

Our Pain management physicians love to code M46.96 for Facet lumbar arthritis of spine. After doing research the physician has to document inflammatory arthritis in order for the code to be correct. The imaging stated the arthritis is degenerative or osteoarthritis which will code to M47.816. Do anyone know if there is an article or coding clinic to help resolve this problem? Do anyone have suggestions?

Please help

Medical Billing and Coding Forum

Lumbar I&D?

Surgeon wants to bill 22015, lumbar incision & drainage, open of deep abscess lumbar. Patient is s/p laminectomy & fusion. Op note states "Inspection of the incision was performed. There was evidence of wound dehiscence with already formation of granulation tissue deep to the skin level. The fascia and the intermediate Scarpa’s fascia/fatty layer appears to have healed well. There was evidence of bleeding bed at both sides of the wound. There was no evidence of discharge or purulent fluid. There was no foul odor. Wound measured 7 cm in length 2cm in the maximum width area and 1.75 cm in maximum depth area. At this time the decision was made to proceed with VAC dressing and closure of surgical incision through secondary intention. Closure through primary intention was not felt to be optimal since the wound has likely been dehisced for about 2-3 weeks. Multiple liter irrigation performed of the surgical wound. Silver nitrate VAC dressing was applied. There was good suction without evidence of leak."

22015 doesn’t seem appropriate to me since he didn’t make an incision, and was thinking of 10060 or 10140 or 12020 or 12021 maybe with 97605? I’m stuck. Any input would be appreciated!

Medical Billing and Coding Forum

Lumbar I&D w/placement of VAC dressing?

Surgeon wants to bill 22015, lumbar incision & drainage, open of deep abscess lumbar. Patient is s/p laminectomy & fusion. Op note states "Inspection of the incision was performed. There was evidence of wound dehiscence with already formation of granulation tissue deep to the skin level. The fascia and the intermediate Scarpa’s fascia/fatty layer appears to have healed well. There was evidence of bleeding bed at both sides of the wound. There was no evidence of discharge or purulent fluid. There was no foul odor. Wound measured 7 cm in length 2cm in the maximum width area and 1.75 cm in maximum depth area. At this time the decision was made to proceed with VAC dressing and closure of surgical incision through secondary intention. Closure through primary intention was not felt to be optimal since the wound has likely been dehisced for about 2-3 weeks. Multiple liter irrigation performed of the surgical wound. Silver nitrate VAC dressing was applied. There was good suction without evidence of leak."

22015 doesn’t seem appropriate to me since he didn’t make an incision, and was thinking of 10060 or 10140 or 12020 or 12021 maybe with 97605? I’m stuck. Any input would be appreciated!

Medical Billing and Coding Forum