Coding Description - 22532 to 22534
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Arthrodesis is performed by lateral extracavitary approach.
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A midline incision is made in the area of the fractured segment and inferiorly curved out to the lateral plane.
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The paraspinous muscles are exposed, lifted off the spinous processes, and divided and lifted off the ribs.
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Imaging must be used to identify the targeted interspace. The corresponding rib is dissected from the intercostal muscles and resected in one piece from the curve to the costovertebral connection.
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The appropriate transverse process and part of the facet and pedicle are removed with a drill from the lateral aspect.
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The dura and the vertebral body are exposed from the dorsolateral view. Further posterior and lateral access to the vertebral body is gained by gently retracting the nerve root and surrounding structures.
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A minimal discectomy is now done to prepare the interspace by removing the damaged tissue with curettes and rongeurs.
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Cartilage is scraped, bone is decorticated, and the arthrodesis is accomplished by tapping bone graft material into the vertebral endplates.
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A drain is placed and closure is done in layers.
Report 22532 for thoracic arthrodesis;
22533 for lumbar arthrodesis
22534 for each additional thoracic or lumbar vertebral segment done by lateral extracavitary approach.
Coding Description - 22548
Spinal arthrodesis, or fusion, may be done for conditions of herniated disc, degenerative, traumatic, and/or congenital lesions, or to stabilize fractures or dislocations of the spine.
Skull tong traction is applied. Avoiding the esophagus, pharynx, or esophageal nerve, the physician may incise the back of the throat, but most often enters from the outside of the neck, left of the throat to reach the C1-C2 (atlas-axis) vertebrae.
Retractors separate the intervertebral muscles.
A drill is inserted in the affected vertebrae and the location confirmed by x-ray.
The physician incises a trough in the front of the vertebrae with a drill or saw.
The physician cleans out the intervertebral disc spaces with a rongeur and removes the cartilaginous plates above and below the vertebrae to be fused.
The odontoid process (dens), the tooth-like projection located on the second cervical vertebra in the neck, may be excised.
The physician obtains and packs separately reportable grafts of iliac or other donor bone into the spaces and trims them.
Traction is gradually decreased to maintain the graft in its bed. The fascia is sutured.
A drain is placed in the incision and the incision is sutured.
What is Fascia ?
Fascia is a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place. The tissue does more than provide internal structure; fascia has nerves that make it almost as sensitive as skin.
What is Trough?
a low area or point, between two higher areas
Cartliagneous place also known as intervertebrate disc.
What is odontoid Process?
The dens, also known as the odontoid process, is a peg-like bone pointing up from the second cervical vertebra (C2) and connects to the first cervical vertebra (C1) and enables head rotation.