Neurosurgery Coding Alert

Know the rules when surgeon performs arthrodesis across multiple interspaces.

The 2019 update to the Correct Coding Initiative (CCI) Policy Manual for Medicare Services is out, bringing plenty of changes marked in bright right italic font in the new version. Take a look at these quick tips to learn the spinal arthrodesis additions you will want to keep track of.

Editor’s note: Stay tuned to the next issue of Neurosurgery Coding Alert to learn even more tips for spinal arthrodesis.

Tip 1: Check Out When to Report Codes 22600-+22614

Spinal arthrodesis additions in the CCI manual specifically outline how to accurately report codes 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment)-+22614 (… each additional vertebral segment (List separately in addition to code for primary procedure)).

You should report codes 22600-+22614 when the surgeon performs arthrodesis using the posterior or posterolateral technique, per the manual.

Don’t miss: You can report add-on code +22614 with primary codes 22600-22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)); or 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar).

Tip 2: Observe These Rules for Codes 22630-+22632

You will also see several clarifications for submitting codes 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar)-+22632 (…; each additional interspace (List separately in addition to code for primary procedure)).

For example, you would report codes 22630-+22632 when the surgeon performs arthrodesis using the posterior interbody technique without posterolateral fusion, according to 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.

Don’t miss: You can report add-on code +22632 with primary codes 22612, 22630, or 22633.

CCI edits: Although there is not a new 2019 procedure-to-procedure (PTP) edit for pair 22630/63056 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)), the manual does offer further clarification for the existing edit.

Code 63056 is bundled into 22630, so you should not report the two procedures together “at the same anatomic site (spinal level) at the same patient encounter,” according to the manual. However, since this edit pair has a modifier indicator of “1,” you can bypass the edit with a modifier like modifier 59 (Distinct procedural service) if the surgeon performs the two procedures “at separate anatomic sites, such as at different spinal levels or separate patient encounters on the same date of service.”

Tip 3: Highlight 22633 and +22634 Guidelines

Don’t miss what the manual has to say about codes 22633 and +22634 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure)).

Codes 22633 and +22634: You should report codes 22633 and +22634 when the surgeon performs arthrodesis using a combined posterior or posterolateral technique with posterior interbody technique, via the manual.

Don’t miss: You should report 22633 and +22634 per level or interspace. Also, you can report add-on code +22634 with primary code 22633.