Neurosurgery Coding Alert

Clinical similarities make it difficult to distinguish an anterior vertebral corpectomy (63081-63091) from an anterior diskectomy (63075-63078), partial excision (22100-22103 and 22110-22116) or osteotomy of spine (22210-22226). All of these spinal surgeries involve removal of bone and/or vertebral disks, and the differences between them must be understood to ensure accurate coding. Also, other procedures such
as arthrodesis and spinal instrumentation may be performed at the same time and may be separately billable.
Report Corpectomy Codes for Removal of Vertebral Body  
Anterior vertebral corpectomy, or vertebral body resection, involves partial or complete removal of the vertebral body. Codes 63081-63091 specify with decompression of spinal cord and/or nerve root(s). They are appropriately reported, according to CPT Coding Made Easy: A Technical Guide, to correct a compressed spinal cord caused by "trauma to a vertebra (such as a fracture), collapse of a vertebra due to bone cancer (degeneration of bone) or other reasons ... " These procedures include diskectomy above and/or below the vertebral body or bodies removed.
 
Also, if a spinal fracture is repaired, the vertebral corpectomy is the definitive treatment. The fracture-care codes may not be reported in addition to 63081-63091. However, arthrodesis (22548-22812, to stabilize the spine) and spinal reconstruction, including bone grafts (20930-20938) and spinal instrumentation (22840-22855), are separately payable. Also, bone-graft and instrumentation codes, although not specifically defined as add-on procedures, "are reported in addition to codes for the definitive procedure(s)" and should not be appended with modifier -51 (multiple procedures), according to CPT. An operating microscope (69990) may be used during these procedures and may be billed for some non-Medicare payers. Code 69990 is an add-on procedure not subject to multiple-procedure reductions.
 
The appropriate code is selected by location (63081, cervical; 63085, thoracic; 63087, lower thoracic or lumbar; or 63090 lower thoracic, lumbar, or sacral). Report the primary-procedure code for the first vertebral segment removed. If additional segments are removed, "list removal of the second and any subsequent vertebral bodies using the appropriate code(s) for 'each additional segment,' " according to CPT Coding Made Easy. The add-on codes -- 63076, 63078, 63082, 63086, 63088 and 63091 -- for each additional segment should be reimbursed at their full value.
 
For example, to treat a compressed nerve of the spine caused by fracture, diskectomies are performed with the aid of an operating microscope, followed by corpectomy of segments C3 and C4. Compressed nerve roots are freed and the site is prepared for spinal reconstruction, which is accomplished using tricortical allograft and titanium plates. The wound is closed using sutured layers. Report the session as follows, listing the primary procedure and its associated add-on codes first:

63081

63082

22554 -- arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C2
 
22585 [...]