Cpt Code 63267 Descriptive Essay

he did do a decompressive laminectomy. here is the senerio:

PREOPERATIVE DIAGNOSES:
1. Lb—Si degenerative spondylolisthesis.
2. Left—sided Lb—Si synovial cyst.
3. L5—S1 instability.
POSTOPERATIVE DIAGNOSES:
1. L5—S1 degenerative spondylolisthesis.
2. Left—sided Lb—Si synovial cyst.
3. L5—S1 instability.
OPERATION PERFORMED:
1. Bilateral L5 Gill procedure for decompression of neural elements.
2. Left—sided Lb—Si synovial cyst resection.
3. L5—Si post lumbar interbody fusion with Pioneer bullet—tip option cages.
4. L5—Sl posterior spinal fusion with Pioneer pedicle screw instrumentation


I began by making the planned incision, carrying it down through copious fat to the lumbodorsal fascia. The lumbodorsal fascia was opened Boyle cautery on either side of midline. I used subperiosteal dissection to expose the spinous processes and lamina of L4, 15, and Si. Up—angled curette was placed under the right 15 lamina and a confirmatory x—ray showed proper level.
I then dissected out laterally to expose the 15 transverse processes and the bilateral sacral ala. Self—retaining retractors were placed.
I then performed bilateral 15 Gill procedure, removing the entire spinous process lamina and inferior facets of 15. The bone was morselized on the back table for fusion purposes. I then widely decompressed the bilateral 15 and Si nerve roots. On the left side of midline, there was a sizable calcified synovial cyst, which was compressing the Sl nerve root. This was carefully and siowly dissected away from the dura without durotomy. Bilateral 15 neuroforaminal also quite stenotic, more so on the left than the right. After the nerve was satisfactorily decompressed, I then worked on either side of midline, retracting the Si nerve roots, to remove the disk material with 15 blade, pituitary rongeurs. The endplates were shaved and scraped with instrumentation from the Pioneer set. Care was taken to preserve the cortical endplates. I sized for an 11 x 22 mm trial, which fit snugly in the disk space on both sides.
Starting on the left side of midline, morseiized autograft from the facetectomy was packed in the disk space and pushed across the midline towards the right. I then placed an 11 x 22 mm Pioneer cage packed with autograft. This was placed into the left side of the 15-Si disk space with countersinking. There was a nice tight fit.
In a similar fashion, bone was packed from the right towards the left and a second 11 x 22 mm cage, filled with morselized autograft, with placed into the 15-Si disk space with countersinking. There was a nice tight fit.
I then prepared for pedicle screws bilaterally measuring 6.5 x 40 mm. Bicortical purchase was obtained at the Si level. Prior to instrumentation placement, the posterolateral region on the left was decorticated and morselized autograft was placed over the 15—Si sacral alar region for fusion purposes.
I then placed the 6.5 x 40 mm pedicle screws in all 4 positions. There was good bony purchase. 1 then placed 40 mm rods between the screw heads. Cap screws were placed. The segment was placed in compression. Cap screws were torqued at all 4 sites. AP and lateral fluoroscopic images showed acceptable placement of interbody cages and pedicle screw instrumentation.
Self retractor then removed. The wound was copiously irrigated. F{emovac drain was placed into the epidural space and tunneled out inferolaterally to the left.

Clinical Labor - Direct Expense

StaffStaff RatePre TimeIntra TimePost TimeTotal Time*
RN/LPN/MTA$0.37  / min## min## min## min## min

* Total Time may be greater than the displayed components.     

Equipment - Direct Expense

ItemPurchase PriceExpected LifeTotal Time
table, exam$##.#### years## min

Supplies - Direct Expense

ItemUnit PriceQuantityUnitAmount
pack, minimum multi-specialty visit$##.##  ##pack$##.##
pack, post-op incision care (suture)$##.##  ##pack$##.##
bandage, Kling, non-sterile 2in$##.##  ##item$##.##

Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.

PE RVU Components (by modifier)

ModifierNational Unadjusted PE RVUPE GPCIAdjusted PE RVU
(none)##.####.##13.89
(MPPR)##.####.##6.95
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