Preoperative Diagnosis: Herniated Nucleus Pulposus of L5-S1 on the Left

Multiple Choice

Preoperative Diagnosis: Herniated nucleus pulposus of L5-S1 on the left.
Postoperative Diagnosis: Herniated nucleus pulposus of L5-S1 on the left.
Procedure Performed: Microscopic assisted lumbar laminotomy with discectomy at L5-S1 on the left.
Surgical Indications: The patient is a 51-year-old female who has had unrelenting low back pain that radiates down her left leg for the past several months. The symptoms were not helped by conservative treatments and were interfering with all aspects of daily living and her job.
Procedure: The patient was taken to the operating room and after anesthesia was administered, she was placed on the Jackson spinal table with the Wilson attachment in the prone position. Palpation revealed the iliac crest and suspected L5-S1 interspace. The lumbar spine was prepped and draped in the usual sterile fashion. A midline incision was made over the spinal process of L5 to S1. Skin and subcutaneous tissue were divided sharply. Electrocautery provided hemostasis. Electrocautery was then utilized to dissect through the subcutaneous tissues to the lumbar fascia. On the left side, superior aspect dissection was carried out with the Cobb elevator and electrocautery. This revealed the interspace of level of L5-S1 on the left. A Kocher clamp was placed between the spinous processes of L5-S1. X-ray confirmed the L5-S1 interval. An angled curet was used to detach the ligamentum flavum from its bony attachments at the inferior edge of the L5 lamina and the superior edge of S1 lamina. Dissection was undertaken and the ligamentum flavum was removed. Laminotomy was created with Kerrison rongeur, both proximally and distally. The microscope was positioned and a blunt Penfield elevator was utilized to dissect and identify the L5-S1 nerve root on the left. It was noted to be tented over a disc extrusion. The nerve root was retracted with a nerve root retractor. This revealed a subligamentous disc herniation at the L5-S1 disc space and neuroforaminal area. A #15 Bard-Parker blade was utilized to create an annulotomy. Medially, disc material was extruding through this annulotomy. Two tier rongeur was then utilized to grasp the disc material and the disc was removed from the interspace. Additional disc material was then removed, both to the right and left of the annulotomy. The Penfield elevator was placed in the disc space of L5-S1 and a crosstable x-ray confirmed this level. Nerve root was inspected exhibiting the foramina. A foraminotomy was created with a Kerrison rongeur. Then the nerve root was again inspected and determined to be free of tension. A free fat graft was then harvested from the subcutaneous tissues and placed over the exposed dura. Lumbar fascia was then approximated with #1 Vicryl interrupted sutures, subcutaneous tissue with #2-0 Vicryl interrupted sutures, and #4-0 undyed Vicryl was utilized to approximate the skin. Compression dressing was applied. Estimated blood loss was less than 50 cc. She tolerated the procedure well and was taken to the recovery room in satisfactory condition.
Select the appropriate CPT and ICD-10-CM codes.

A) 63042-LT, M51.27
B) 63030-LT, 63035-LT -51, S33.39XA
C) 63030-LT, M51.27
D) 63005-LT, 63011-LT -51, S33.39XA