This month’s operation report features Spinal Adhesion Barriers. The practice of using spinal adhesions within laminectomies is nothing new and this is considered a standard of practice that is essential for good patient recovery. When performing these operations, there are additional questions to be asked about the coding and billing involved. Continue reading below to learn more!
Do you have a complicated surgery case that needs help with coding? RT Welter would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient-protected health information and organization identifiers. RT Welter will not use any medical records submitted in which PHI is not removed and protected.
Questions to Consider:
- How is your spinal practice coding/billing for this additional work?
- HCPCS code C1765 is used to bill for the device but how are your surgeons being reimbursed?
DATE OF SURGERY: 12/XX/2020
SURGEON: D., MD
ASSISTANT SURGEON: M., SA-C
PREOPERATIVE DIAGNOSIS: Degenerative lumbosacral spine (LS through S1).
POSTOPERATIVE DIAGNOSIS: Degenerative lumbosacral spine (LS through S1).
OPERATIONS: Anterior exposure for lumbosacral spine fusion (L5-S1). Intraoperative fluoroscopy. Vessel Guard patch. Abdominal x-ray reading.
SPINE SURGEON: Dr. G. G.
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal
INDICATION FOR SURGERY: This is a 49-year-old male with degenerative lumbosacral spine, who needs anterior exposure £or fusion at the level of the disk LS-Sl.
DESCRIPTION OF PROCEDURE:
The patient was brought into the operating room and placed on the table in supine position. After general anesthesia was administered, the intraoperative fluoroscopy was used to identify the level of the disk L5-S1 and the projection of the disk at the level of the anterior abdominal wall was marked with a transversal line in the suprapubic area. The abdomen was prepped and draped in the usual sterile fashion.
A small transversal incision was done in the suprapubic area on top of the previously placed line and the incision was deepened through the subcutaneous tissue and through the fascia. The fascia flaps were elevated, and at the level of the midline between the rectus muscles, the peritoneal sac was approached and gently dissected and pushed to the left side. It was a little bit more difficult to enter the right retroperitoneal space and below the arcuate line, but it was possible to enter without any complications. The right retroperitoneal space was entered, and the peritoneal sac was further mobilized together. The ureter was pushed to the left side. The ureter was protected and visualized at all time. The vascular dissection was started between the iliac vessels using only gentle blunt dissection to avoid, injuries to the superior hypogastric plexus in this young man. Few presacral veins were identified and divided using bipolar electrocautery and middle sacral artery which was well represented partially imbedded in the soft tissue in front of the spine was divided using bipolar electrocautery, obtaining a good hemostasis. The vascular dissection was further continued using blunt dissection until both iliac vessels were mobilized, completed the right and left side of the spine obtaining a complete clearance of the entire disk space LS-S1. A needle was inserted in the disk exposed, and using intraoperative fluoroscopy, the level of the spine exposure was demonstrated.
The SynFrame was placed maintaining the exposure at the level of the disk LS-S1. At this point, Dr. G. came into the operating room and the case was turned to Dr. G. for the orthopedic part of the spinal fusion. After his part of surgery was completed, I came back to the operating room and I took over the case again. very good hemostasis was noted. No injury was seen. At this point, a Vessel Guard patch measuring 5 x 7.5 cm was chosen, was tailored to match the shape of the vertebral space exposed and secured in place with 2 stitches for 4-0 PDS suturing the upper part of the patch to the anterior longitudinal ligament of the vertebral body LS. The patch was able to cover completely the entire anterior aspect of the spine exposed and the hardware used for the fusion. The retractor blades were very carefully gently removed allowing the iliac vessels and the peritoneal sac to come back in a normal anatomical position on top of the patch. At the end of the procedure, very good hemostasis was noticed, very good flow through the iliac vessels. No ureteral injuries and no lymphatic leak.
The abdomen was closed in a standard fashion using a stitch with O Vicryl to approximate the rectus muscle below the midline and then the anterior fascia layer was closed with continuous running O loop PDS. The subcutaneous tissue was irrigated. Local anesthesia was injected. At this point, the intraoperative fluoroscopy was used to x-ray the abdomen for the instrument count and no instruments were found in the surgical field. The subcutaneous tissue was closed with continuous running 2-0 Vicryl, and the skin was closed with continuous running 3-0 Monocryl subcuticular closure. Steri-strips and sterile dressing were applied.
The patient tolerated the procedure well. At this point, the patient was kept under general anesthesia and turned back to Dr. G. and anesthesiologist for the posterior part of the spinal fusion.