Neurosurgery Coding Alert

Append modifiers to grafts, open procedure, fracture reduction, and arthodesis with posterior arch excision.

The latest round of NCCI edits (18.1) may affect the way you report arthrodesis, tissue grafts, and fracture reduction with excision of a posterior vertebral component. Read on for advice on how to navigate the edits, effective April 1, 2012.

The code 22100 (Partial excision of posterior vertebral component [e.g., spinous process, lamina or facet] for intrinsic bony lesion, single vertebral segment; cervical) for partial excision of a posterior vertebral component has a number of codes that cannot be billed together without an allowable modifier.

Another similar situation you will face is with codes 22101 (Partial excision of posterior vertebral component [e.g., spinous process, lamina or facet] for intrinsic bony lesion, single vertebral segment; thoracic), and 22102 (Partial excision of posterior vertebral component [e.g., spinous process, lamina or facet] for intrinsic bony lesion, single vertebral segment; lumbar), which again cannot be billed together with other codes without an allowable modifier.

"These codes are intended for the excision of bony lesions of the posterior elements excluding the vertebral body, such as benign tumors of infectious lesions," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

The recent NCCI edits (18.1) allow the following codes to be reported with 22100 but only under justifiable circumstances:

• 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis])
• 22326 (Open treatment and/or reduction of vertebral fracture[s] and/or dislocation[s], posterior approach, 1 fractured vertebra or dislocated segment; cervical)
• 22800 (Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments)
• 22802 (Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments)
• 22804 (Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments)

Similarly, for 22101, the codes 20926, 22327 (Open treatment and/or reduction of vertebral fracture[s] and/or dislocation[s], posterior approach, 1 fractured vertebra or dislocated segment; thoracic), 22800, 22802, and 22804 are reported together only with appropriate modifiers.

Example: If you read that your surgeon excised a part of the vertebral laminae to remove the tumor in T6 and then performed an arthrodesis for thoracic spinal deformity, you can report 22101 and 22800 only if you append modifier -59 to code 22101.