Medicare Compliance & Reimbursement

Spine surgeons stiffen their backbones in opposition to bundle.

Watch out: A new Correct Coding Initiative edit could make life more difficult if your surgeon performs two common spine procedures together.

The edit: CCI Version 12.1 bundles 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) into 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]).

Code 22630 (often reported for a posterior lumbar interbody fusion (PLIF)) pays upwards of $1,500. Surgeons Stand Up In Opposition “I am vehemently against the new edit,” says Douglas Ehrler, MD, an orthopedic surgeon at the Crystal Clinic in Akron, OH. The edit can be overridden with a modifier, so he intends to append modifier 59 to 22630 and submit a cover letter indicating exactly why he feels the PLIF is a separate procedure.

Here’s the difference between the procedures: “A posterior lateral fusion [22612] involves laying bone graft in the posterior lateral gutters,” Ehrler says. “That is decortication of the transverse processes, facets, and packing bone in that area. This can be augmented with pedicle screws.” This only involves exposing the facets and transverse processes in that region, and then packing bone graft.

A PLIF (22630), on the other hand, fuses the anterior and middle columns of the spine, Ehrler explains. “The interbody fusion fuses where a disc space is, thus fusing the endplates of the two vertebrae together.” This doesn’t fuse the posterior lateral region of the spine, which 22612 covers.

“Adding the 22612 poster lateral fusion to the 22630 fusion increases the likelihood of fusion and therefore the chance of pain relief,” says James Hollowell, a neurosurgeon in Milwaukee, WI who specializes in spine surgeries. It’s true that studies conflict on the merits of performing both procedures, and there’s no convincing body of evidence either way, he notes. But 22630 “clearly requires additional work and should be compensated accordingly,” the neurosurgeon says. Separate Spine Areas Should Lead To Separate Pay Surgeons may combine both procedures to combat extreme structural instability and/or for the oblation of a degenerative disc. But the surgeries occur in two separate areas of the spine. “They can be fused independently or in combination with each other,” Ehrler says. “Therefore, they are totally not mutually inclusive of one another.”

Not only does the surgeon spend more time with the patient to add a PLIF to the fusion, but the patient is under greater risk. “You risk neurologic structures such as dura or nerve roots” during the PLIF, Ehrler says. [...]