Neurosurgery Coding Alert

Justification: CPT states, "Report modifier 51 (Multiple procedures) with 22849, 22850, 22852 and 22855 when instrumentation reinsertion or removal is reported with ... definitive procedures such as arthrodesis, decompression, and exploration of fusion."

Possible roadblock: The National Correct Coding Initiative has not caught up with this CPT revision, and still bundles 22830 into 22850, 22852 and 22855. If your insurer continues to deny your instrumentation removal claims when you report spinal fusion, copy the applicable page of CPT (the notation is printed directly above code 22830's descriptor), and send it with your appeal, along with a short letter from the surgeon.

Myth #2: You can bill corpectomy with lumbar interbody fusion.

Your spine surgeon turns in this operative note:

"I performed a transforaminal lumbar interbody fusion at L4-5, and performed osteotomy anteriorly in the disc space to augment the fusion and posteriorly to facilitate placement of the cages. I prepared the end plates and packed autograft bone anteriorly and laterally, then placed 9x22mm cages packed with cancellous autograft."

Your surgeon recommends that you report the arthrodesis code along with a partial corpectomy (63087, Vertebral corpectomy [vertebral body resection], partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root[s], lower thoracic or lumbar; single segment). He's just been sucked into myth number two.

Reality: Don't report the corpectomy, says Matthew Twetten, manager of health policy and reimbursement at the North American Spine Society (NASS).

Right way: You should report the following codes, Twetten says:

"In this scenario, the spine surgeon is incorrect in billing a partial corpectomy, and to do so is to engage in misleading overbilling, something NASS adamantly advises all practitioners from engaging in," Twetten says.

Myth #3: Carriers are probably correct in bundling anterior surgeries with posterior procedures.
 
If your surgeon performs both posterior and anterior surgeries on a patient on the same date, you should not have to write off payment for either of the procedures.

For example, if your surgeon performs anterior interbody arthrodesis (22554) and posterior arthrodesis (22600), your insurer should not bundle 22554 into 22600. But many carriers do just that.

Surgeons perform anterior and posterior surgeries through separate exposures, and the work is completely separate, Przybylski says.

Strategy: Practices that face such denials should arrange for the surgeon to meet the payer representative, Przybylski advises. The surgeon can explain that the surgeries are separate from one another and describe how an arthrodesis on one side of the spine has nothing to do with the other side.