Neurosurgery Coding Alert

The surgeon must perform a bone graft to complete a standard PLIF

Posterior lumbar interbody fusion (PLIF) claims always contain at least two CPT codes, and they often include more. Leaving just one of these codes off the claim can cause the practice to miss out on rightful reimbursement.
 
Check out this primer on how to put all of the pieces together correctly for a proper PLIF claim. Code for Each Interspace the Surgeon Treats
 
During a PLIF, the neurosurgeon will treat one or more vertebral interspaces. Coders must remember to report each interspace treatment in a PLIF encounter separately, says Katherine Phelan, CPC, coding and billing consultant in Tulsa, Okla.

When you are coding for a standard PLIF procedure, you should report 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) for the first interspace.
 
Code any additional interspaces with +22632 (- each additional interspace [list separately in addition to code for primary procedure]), says Nancy Reading, RN, BS, CPC, director of educational services for the American Academy of Professional Coders.
 
Remember: Never report 22632 unless you are also reporting 22630, Phelan says. -The 22632 code is an add-on code you use in addition to 22630 when the interbody fusion is performed across more than one interspace,- she says.
 
You-ll also want to be sure to prove medical necessity for the PLIF procedure through precise ICD-9 coding. If you are unsure which ICD-9 codes will provide medical necessity for PLIF, check with your insurer.
 
According to Kathleen Pratt, CPC, coder at Mercy Neurosurgery in Janesville, Wis., these are some of the diagnoses that her insurers accept for 22630 and 22632:

 - 721.3 -- Lumbosacral spondylosis without myelopathy
 - 721.42 -- Lumbar spondylosis with myelopathy
 - 722.52 -- Degeneration of lumbar or lumbosacral intervertebral disc
 - 722.83 -- Postlaminectomy syndrome; lumbar region
 - 724.02 -- Spinal stenosis; lumbar region.

Choose Bone Graft Code Carefully During the PLIF procedure, the neurosurgeon will need to place bone grafts to stabilize the spine. You-ll choose the bone graft procedure codes from 20930-20938. Pay attention to the surgeon's notes when choosing a bone graft code because the surgeon can perform the bone graft using one of several methods.
 
-The standard in the past with PLIFs was to harvest bone from the iliac crest through a separate incision and code with 20937 (Autograft for spine surgery only [includes harvesting the graft]; morselized [through separate skin or fascial incision]) or 20938 (- structural, bicortical or tricortical [through separate skin or fascial incision]),- Phelan says.
 
The problem with these autografts is that there is potential for both post-op patient pain and chronic pain at the harvest site, she says.
 
Another technique her surgeons might choose is a bone morphogenic protein [...]