Coding Review (help): not sure about these spinal codes

Here is one for the group:
Diagnosis: Left L5-S1 facet ganglion tumor with spondylolisthesis

Report detail (abridged): Physician performed a subperiosteal dissection uncovering the lamina of L5-S1. used a McCullough retractor position. A high speed drill was used to remove the lamina at L5-S1. The facet ganglion was hugh and attached to the lumbosacral dura. The ganglion was peeled off under a very high powered microsacope and the dura was preserved. After the decompression the physician deviated to the disk space over asnd removed all the disk material at L5-S1 where the spondylolisthesis was present. Physician identified the pedicle screws, the pedicles at L5 and S1 and perforated them with the gearshift and placed the distraction pins. The physician then increased the distraction pins, removed all disk material and scraped the cartilaginous plates free and with careful retraction tamped in an ardis Implant into the joint space after having cleaned the whole joint space out of L5-S1. After this work the physician placed the distraction pins to include TiTLE 2 implants. After locking everythinf into place the physician finished the lateral fusing making sure there was bone marrow and infuse in addition in the disk space and in the lateral gutter of the facet joints.
My coding: 756.12, 215.8
22612, 22851, 20936, 22840, 63102

Jun 30th, 2009 -

Not sure if anyone answered but here are my thoughts. There is no mention of a corpectomy to justify using 63102. The physician did an interbody fusion which you did not code. You also did not code for the Infuse or bone marrow aspiration. I don't see evidence of using local bone for the fusion to justify 20936. The discectomy will be included in 22630 (interbody fusion).

Here are the codes I suggest in descending RVU order (except 69990 is listed just after code with which microscope is used):
22612 Posterolateral fusion L5-S1
63277-51 Laminectomy for neoplasm, extradural (removal of facet ganglion tumor) - be sure there is a preop/postop diagnosis for this. May need modifier 59 if payor bundles this into 22630 to show it was a separate procedure.
69990 Use of the operating microscope for microdissection (CPT says ok to code - Medicare will not reimburse)
22630-51 Posterior lumbar interbody fusion L5-S1
22840 Instrumentation (TiTLE 2, pedicle screws)
22851 Ardis implant (eg, PEEK)
38220-51 Bone marrow aspiration - code this only if the aspirate came from the iliac crest. If the aspirate came from the pedicle (locally) then do not report the code)
20930 Infuse

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com