Neurosurgery Coding Alert

Report 63047 and +63048 with care.

As you’re reading the 2019 Correct Coding Initiative (CCI) manual, you will notice bright red italic font alerting you to vital updates, including some for spinal arthrodesis you should be aware of.

Read on to always keep your spinal arthrodesis claims in tip-top shape.

Observe Rules When Surgeon Performs Arthrodesis Performed Across Multiple Interspaces

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

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

The rules: 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.

Follow These Instructions for 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 surgeon 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 surgeon performs spinal arthrodesis across multiple non-contiguous interspaces, follow these rules:

• The surgeon 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 surgeon 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.

Reporting Codes 63047 and +63048 With 22630-+22634? Read This

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 the Correct Coding Initiative (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. Stay tuned for further updates.