Osteotomy Root Operation
Barbra Lidder
Q: From your previous presentation, it was stated a corpectomy should not be coded when performed with a fusion unless for example done to remove a tumor. Why is excision of disc coded separately during a fusion but not a corpectomy? The intent of the procedure is the same - to fuse the spine?
A: There is no official guidance for reporting corpectomy when performed in addition to a spinal fusion. After discussion with other spinal fusion coding experts, we agreed that removal of bone is always necessary to prepare the joint for fusion. Except for corpectomy for a malignancy, the intent of the procedure is to fuse the joint. With a malignancy, the intent of the procedure is to remove the neoplastic tumor before fusing the spine. As for discectomy, there is official advice that states that it should be reported in addition to spinal fusion, even though one could argue that it is necessary to prepare the interspace for spinal fusion. We submitted a letter to Coding Clinic asking for clarification and will update our advice once we receive an answer.
Updated 1/24/22: In the two operative reports we sent as supporting documentation with the question, Coding Clinic responded that corpectomy was done for decompression and it should be reported with root operation "Release." They did not recommend coding corpectomy to the root operation Excision or Resection. Based on this advice, each operative report would stand on its own. If its documented that the corpectomy was performed to release a nerve root or spinal cord, it is coded to Release.
Q: After a corpectomy is performed and the vertebrae are repositioned, a physician will document that the anterior fusion was performed with "apposition" however they don't indicate bone graft was placed. Is it proper to call that a fusion?
A: Apposition is defined as the process of placing in juxtaposition or proximity. This means that the surgeon is positioning the spine into proper alignment and is not the same as fusion. Without specific documentation that bone graft was used, this should not be coded as a spinal fusion. In addition to the operative report, a spinal implant log may contain additional information about whether bone graft material was used.
Q: I have a doctor who wants an osteotomy coded but he does not document any spinal deformity. Can you code the osteotomy in that case?
A: In ICD-10-PCS, root operations are assigned based on procedural intent. In our discussion on osteotomies for correction of spinal deformities, the intent of the osteotomy procedure is to bring the spine into proper alignment. As such, the root operation for osteotomy for spinal deformity is Reposition. If there is no spinal deformity documented, we recommend querying the surgeon for the intent of the osteotomy. If there is no spinal deformity, then the Reposition root operation would not be appropriate.Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS TrainerSenior Consultant
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Background: This study aimed to verify whether the presence of medial meniscus posterior root tear (MMPRT) affects the clinical and radiographic outcomes of medial open-wedge high tibial osteotomy (MOWHTO) compared to the patients without MMPRT for over a midterm follow-up.
Methods: One hundred fifty-six knees were retrospectively enrolled that underwent MOWHTO and second-look arthroscopy concomitantly with a minimum 5 years of follow-up. Seventy-four knees with MMPRT (MMPRT group) were identified. Eighty-two knees with intact MMPR were assigned to another group (MMPRI group). All knees with torn medial meniscus with or without MMPRT had an arthroscopic partial meniscectomy during the MOWHTO. Clinical evaluation included range of motion, American Knee Society scores, and Western Ontario and McMaster Universities Osteoarthritis Index scores. Radiologically, the Kellgren-Lawrence grade was assessed preoperatively and at the latest follow-up. Cartilage status was also compared through the 2-stage arthroscopy according to the International Cartilage Repair Society grading.
Results: Average age at operation was 55.8 years (range 42-67), and the average follow-up period was 82.2 months (range 60-148). There were no significant differences in clinical outcomes between the groups. Postoperative changes in Kellgren-Lawrence grade and arthroscopic cartilage status showed no significant differences between the groups. Resected MMPR was remodeled in 41.9% (31/74) of the MMPRT group through the second-look arthroscopy.
Introduction: The aim of the study is to investigate whether the 3-dimensional dynamic navigation system (3D-DNS) can improve experienced endodontists' (EEs') and novice endodontists' (NEs') accuracy and efficiency in osteotomy and root-end resection (RER) and to verify that the 3D-DNS enables NEs to perform osteotomy and RER as accurately and efficiently as EEs.
Methods: Seventy-six roots in cadaver heads were randomly divided into 4 groups: 3D-DNS-NE, 3D-DNS-EE, freehanded (FH)-NE, and FH-EE (all, n = 19). Cone-beam computed tomography scans were taken preoperatively and postoperatively. Osteotomy and RER were planned virtually in the X-guided software (X-Nav Technologies, Lansdale). Accuracy was calculated by measuring the 2-dimensional and 3D virtual deviations and angular deflection using superimposing software (X-Nav technologies). Efficiency was determined by the time of operation and the number of mishaps.
Conclusions: The 3D-DNS improved EEs' and NEs' accuracy and efficiency in osteotomy and RER. The NEs were as efficient as the EEs using the 3D-DNS. Notably, the 3D-DNS improved the NEs' accuracy compared to the FH method, but the 3D-DNS did not enable the NEs to perform osteotomy and RER as accurately as the EEs.
Favorable clinical results have been reported following high tibial osteotomy (HTO) for medial meniscus posterior root tear (MMPRT) in knees with varus alignment. However, the effect on the preoperative neutral alignment of the knee is not known. This study sought to evaluate the clinical outcomes of medial open-wedge HTO for MMPRT with neutral alignment.
There were 11 knees in the moderate varus alignment group and 11 in the varus alignment group. In terms of perioperative patient-reported outcome measures, there was no significant difference in the preoperative or postoperative KOOS subscale score or FJS-12 score between the moderate varus and varus alignment groups. The healing rate was significantly higher in the moderate varus alignment group.
Favorable clinical results were obtained by medial open-wedge HTO in knees with MMPRT and moderate varus alignment in the short term. Surgeons should consider the indications for medial open-wedge HTO, even with moderate varus alignment, when planning treatment for MMPRT with persistent knee pain.
The purpose of this study was to evaluate the clinical outcomes of medial open-wedge HTO for MMPRT in well-aligned knees. The hypothesis was that medial open-wedge HTO for MMPRT in a well-aligned knee would have an outcome similar to that of medial open-wedge HTO for MMPRT in a knee with varus alignment.
The surgical procedures were performed by any of four specialist knee surgeons, with attention paid to consistency in surgical techniques used and intraoperative management across cases. HTO was performed by the medial open-wedge HTO (Fig. 1) or medial open-wedge distal tibial tuberosity osteotomy (DTO) (Fig. 2) method using a long locking plate (TriS, Olympus Terumo Biomaterials, Tokyo, Japan) [2, 7, 12]. In open-wedge DTO, the tibial tuberosity remains attached to the proximal tibia, and bi- cortical screw fixation from the tuberosity to the posterior tibia was performed to support the descending osteotomy [2]. The surgical procedure was chosen by the surgeon based on the patellofemoral joint problem. Patients with symptomatic patellofemoral joint space narrowing and/or osteophytes were excluded [10]. In all cases, artificial bone (OSferion 60, Olympus Terumo Biomaterials, Tokyo, Japan) was inserted into the osteotomy site. The correction angle was determined by aiming for a postoperative weight-bearing axis at a point 62.5% lateral to the transverse diameter of the tibial plateau on double-limb standing full-length lower extremity radiographs [6, 11].
Concurrent arthroscopic resection or repair using an all-inside meniscal suture device (TrueSpan, DePuy Mitek, Inc., Raynham, MA; Fast-Fix 360, Smith & Nephew Endoscopy, Andover, MA) was performed for MMPRT at the discretion of the surgeon. None of the knees underwent a transtibial pullout repair for MMPRT.
Intraobserver reliability of measurements was assessed using the intraclass correlation coefficient (ICC). Measurements were repeated after a 2-week interval to evaluate the ICC for the radiological parameter (HKA angle) in all 22 knees. The ICC for intraobserver agreement of the radiological HKA angle was 0.92.
To evaluate patient-reported outcome measures (PROMs), patients were asked to complete the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score-12 (FJS-12) preoperatively and postoperatively by the attending surgeon. Postoperative PROMs were measured at the final outpatient visit more than 1 year after surgery.
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