Anesthesia Coding Alert

Pay special attention to spaces and incision sites.

The newest round of Correct Coding Initiative (CCI) edits for 2019 holds special interest for those who report pain management services, thanks to new bundles that involve spinal arthrodesis codes. Read on for advice on following the CCI edits as intended.

Follow the Rules for Arthrodesis Involving Multiple Interspaces

The CCI manual gives you very specific instructions for reporting arthrodesis across multiple interspaces. Take a look at three possible scenarios:

• Scenario 1: The physician performs arthrodesis across multiple interspaces, and he uses the same technique for the same spinal region.
• Scenario 2: The physician performs arthrodesis and the interspaces “span two different spinal regions through the same skin incision.”
• Scenario 3: The physician performs arthrodesis and the interspaces “span two different spinal regions through different skin incisions.”

Code it: For scenarios one and two, you should report the correct primary code for the first interspace and the appropriate add-on code for each additional interspace. For the third scenario, you should report the correct primary code “for the first interspace through each skin incision and an add-on code for each additional interspace through the same skin incision,” according to the manual.

Study Up on Multiple Contiguous, Non-Contiguous Interspaces

The manual also specifies how you should report spinal arthrodesis across multiple contiguous and non-contiguous interspaces.

Contiguous: For example, if the physician performs the arthrodesis across multiple contiguous interspaces, and he uses the same skin incision, but he uses different techniques, you should report the appropriate primary code for the first interspace, followed by the appropriate add-on codes for each additional interspace.

Non-contiguous: On the other hand, if the physician performs spinal arthrodesis across multiple non-contiguous interspaces, follow these rules:

• The physician performs arthrodesis across multiple non-contiguous interspaces through the same skin incision, but he uses different techniques. You should report the correct primary code for the first interspace and the appropriate add-on codes for each additional interspace.
• The physician performs arthrodesis across multiple non-contiguous interspaces through different skin incisions, and he uses different techniques. You should report “one primary code for the first interspace through each skin incision.” Then you would report the appropriate “add-on codes for each additional interspace through the same skin incision,” according to the manual.

Pay Close Attention to 22630-+22634

The correct reporting of laminectomy codes with posterior lumbar interbody fusion codes remains unclear, says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey.

While the laminectomy codes are reportable at other interspace levels where a posterior lumbar interbody fusion was not performed when appended with modifier 59 (Distinct procedural service), there have been a number of actions over the past decade between CCI and CPT^® Assistant to provide guidance, according to Przybylski.

While CMS considers 63047 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar) and +63048 (… each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)) inclusive to the posterior lumbar interbody fusion at the same interspace, it was not until the October 2016 CPT^® Assistant that CPT^® advised the same, Przybylski explains. However, this decision was retracted in a May 2018 CPT^® Assistant article.

The professional medical associations who oversee spinal procedures are tasked with developing guidance for correct reporting, Przybylski adds.