# spine surgery questions, help!



## claning (Aug 31, 2012)

Good Morning,

I am reviewing a charge in our office and would like to verify the codes we have chosen, this feels like a dozy to me! Assume all documentation is complete... we got 22633, 63047 22842, 22634, 63048 x2, 20930, 20936

1. L4-S1 posterolateral fusion
2. L4-L5 and L5-S1 posterior interbody fusion
3. L4-S1 posterior segmental pedicle screw and rod instrumentation SGI)
4. Use of deep structural interbody graft composed interbody fusion augmentation, L4-L5, L5-S1 (SGI)
5. L1-S1 laminectomy
6. Use of morcellized laminectimy autograft plus cancellous allograft bone graft plus synthetic allograft bone graft for posterolateral  and posterior interbody instrumentation L4-S1
7. Bone marrow aspirate via transpedicular approach for bone grafting purposes
8. intraoperative neuromonitoring for spinal surgery

thank you,
Any help would be greatly appreciated!

carol laning


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## afeaster72 (Sep 6, 2012)

I get 
22633- 1st level of interbody/lateral fusion
22634- 2nd level of interbody/lateral fusion
22842- istrumentation
20930-grafting
20936-grafting
63047,59 (if done for decompression NOT to prepare the interspace)
I only see one Laminectomy listed (or are you thinking L4, L5 & S1?
If so, then the 63048x2 makes sense (again, only if done for decompression) 
That's all I got!


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## alb7585 (Sep 6, 2012)

I get:

22633: L5-S1 posterior interbody fusion & posterolateral fusion
22630: L4-L5 posterior interbody fusion
63047 - 59: L1-S1 laminectomy
22842: Instrumentation

and you can code the 22930 and 22936 but they are typically bundled into the major procedure


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## mrichmond (Sep 10, 2012)

I am billing a very similar case where the Laminectomy 63047 was done for decompression of the nerve roots due to severe stenosis along with the fusion.  I am in NC and I am billing for a BCBSNC patient.  BCBSNC issued a medical policy in 6/2011 regarding the use of modifiers. 
The policy states:
Modifier -59 designates that a procedure is distinct or independent from another nonevaluation and management service performed on the same day.
Modifier -59 will not allow additional payment when appended to CPT4 codes 63005, 63012,63017, 63030, 63035, 63042, 63044, 63047 and 63048 and when performed in conjunction with 22630 and 22632. Based on the most common clinical scenario, it is expected that when a lumbar laminectomy, facetectomy, and/or foraminotomy is billed with a lumbar arthrodesis,
posterior interbody technique, the procedures are being performed on the same level. In the unusual clinical circumstance when the procedures are performed at different vertebral levels, clinical information will be required to be submitted on appeal.

Any recommendations on how to bill for the fusion and the laminectomy that was done for more than just preparation for the fusion bed but for decompression of the nerve roots due to severe stenosis at the same level.

Any help is appreciated!


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