Let Vocabulary Be Your Guide When Selecting Among Spinal Codes
Published on Sun Jun 01, 2003
Coders trying to decipher operative reports cannot always easily tell the difference among anterior vertebral corpectomy (63081-63091), anterior diskectomy (63075-63078), partial excision (22100-22103, 22110-22116) and osteotomy of spine (22210-22226). By carefully searching documentation for key words and phrases, you can more accurately identify these procedures and ensure appropriate reporting.
Know Your Terms
The best method to distinguish among spinal procedures is simply to know your terminology. For example, anterior vertebral corpectomy (also called vertebral body resection) involves complete or near complete removal of the vertebral body (corpus = body, and ectomy = removal). The surgeon may perform the procedure either with (63081-63091) or without (63300-63308) decompression of the spinal cord and/or nerve root(s). In the case of 63300-63308, the corpectomy is not the goal of the procedure. Rather, the bone removal is necessary to access and remove an intraspinal lesion(s). All vertebral corpectomy procedures include diskectomy (that is, removal of the adjacent intervertebral disks). Like 63081-63091, 63075-63078 include decompression of the spinal cord, but these procedures describe removal of intervertebral disc(s) and osteophyte(s) (osteo = bone, and phyte = growth) only. The body of the vertebra remains intact, and therefore these procedures are somewhat less extensive than either 63081-63091 or 63300-63308. Excision codes 22100-22103 can also apply when the surgeon removes a posterior component (for instance, the spinous process), rather than the body, of the vertebra(e). In this case, however, there is no decompression or diskectomy. These are strictly "bony" procedures to remove damage or disease. Finally, osteotomy codes 22210-22226 also describe removal of a portion of vertebral segment(s) (osteo = bone, and otomy = incision or "cutting into"). These procedures do not include decompression (in contrast to 63081-63091), but may include diskectomy. "The purpose of these procedures is not to release pressure from the spinal cord or nerve root(s), but to correct a spinal deformity," says Kee D. Kim, MD, associate professor in the department of neurosurgery at the University of California at Davis in Sacramento.
With a basic understanding of terminology, you can search the operative report for key words that will allow you to select the appropriate code category (see article "Search for Key Words"). Note: Always be sure to read the operative report thoroughly and not just the procedure descriptor at the top. The "named" procedure and "described" procedure do not always match. When in doubt, code according to the body of the operative report. Don't Report Fracture Repair With Corpectomy If the surgeon repairs spinal fracture with a vertebral corpectomy (as is often the case), the latter is the definitive treatment. You may not report fracture care treatment codes in addition to 63081-63091. On the other hand, you may separately bill arthrodesis (22548-22812, to stabilize the spine) [...]
