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AHA Coding Clinic® for HCPCS - 2024 Issue 2; Ask the Editor

Thoracic transforaminal anterior interbody fusion

A patient with a history of transforaminal discectomy at T10-T11 presents for treatment of thoracic myelopathy with recurrent herniated disc at T10-T11 and spondylosis at T11-T12. Linear and midline incisions were made overlying the spinous process of T8 or T9 and dissection was carried into the subcutaneous tissue, thus isolating a thoracic spinous process via electrocautery. An O-arm image was obtained and registered into the neuro-navigation system. The appropriate levels of T10, T11, and T12 were determined.Using neuro-navigation system for 3D visualization, pilot holes were drilled in the pedicles of T10, T11, and T12 with 5.5 x 45 mm pedicle screws inserted in each pedicle. Once normal anatomy was reached at T11-T12, the laminar defect at T10-T11 was located. The old laminectomy margins were identified at the T10 nerve root. Scar tissue was dissected away under direct visualization. The superior aspect of the T11 pedicle was drilled down to reach the T10-T11 disc. A herniated disc underneath the nerve root and the thecal sac was found and reduced into view with a curette, as multiple fragments were removed. The drill was used to drill down the osteophyte in the neural foramen. The disc space was entered with micro-pituitary forceps and multiple fragments of disc material were removed. The endplates were prepared for the graft. A titanium structural insert measuring 7 mm was introduced onto the field and the disc space was filled with Formagraft®. With guidance from the neuro-navigation system, the implant was inserted into the interspace. This was done with the level distracted using the instrumentation system providing distraction device. Distraction on the pedicles at T10 and T11 were then relaxed.Placement of the pedicle screws and the implant were confirmed by the O-arm image. The facet at T11-T12 on the left was decorticated with a high-speed drill. A discectomy was not performed but decision made to stabilize it with the instrumentation. An appropriate length rod was bent to fit the patient’s spinal curvature. This was introduced into the stabilization system and locked into place. Exposed dura at T10-T11 was covered with Dura-Seal®. Formagraft was placed along the facet and lamina on the left at T11-T12. The connecting rod was inserted and locked into place.What is the appropriate CPT code(s) for a thoracic transforaminal anterior interbody fusion at T10-T11? What is the appropriate CPT code for the posterior fusion at T11-T12? ...

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