Maximize Billing for Instrumentation Procedures
Published on Tue Feb 01, 2000
On Sunday, Jan. 23, Kansas City Chiefs linebacker Derrick Thomas was thrown from a speeding car after losing control on an icy highway. Thomas, who holds the National Football Leagues one-game record for seven sacks, under-went four hours of surgery, including decompression of the spinal cord, stabilization of the spinal column with screws, titanium rods and hooks, and the implantation of bone grafts from his hips. His spine was bruised but not severed.
Surgeries like the one performed on Thomas are far from rare, and a key component to any such surgery is instrumentation. Unfortunately for some neurosurgeons, gaining prompt and proper reimbursement for this critical element of many spinal surgeries can prove difficult.
Laurie Castillo, MA, CPC, president of Physician Coding and Compliance Consulting, a physician consulting firm in Manassas, Va., and a coding expert on neurosurgery, details how a similar case involving an arthrodesis with autogenous bone graft would be coded.
In this case, four vertebrae were shattered due to trauma, and the spine was reconstructed. The following surgical example is for a posterolateral arthrodesis. The procedure encompasses the fusion of the lamina, facets and transverse processes. Iliac bone is used for the graft. Based on this information, the procedure should be coded:
63087vertebral 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
63088x3three additional segments
22612-51arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique); multiple procedures
22614x3three additional vertebral segments
22842posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (Proximal hooks at T-11, rods, intermediate hooks between T12-L1, L1-L2, L2-L3, L3-L4, and distal hooks between L4 and L5)
20938autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision)
Castillo notes that instrumentation is reported separately in addition to the arthrodesis. The instrumentation codes in this example are modifier -51 (multiple procedures) exempt, not add-on codes. Modifier -51 exempt codes are considered a component of the surgery but not bundled into the primary procedure.
Billing for Co-surgeries With Instrumentation
Eric Sandham, CPC, acompliance educator at Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, reports that a major problem that often arises when billing for the installation of instrumentation involves co-surgeries.
In the operating room, one surgeon may perform the primary procedure and fusion while the other handles the instrumentation, says Sandham. Under these circumstances, the surgeons also must work together when billing for their work. [...]
