Neurosurgery Coding Alert

Coders await official stances from NASS and AAOS

If your neurosurgery practice is feeling the strain of the latest major NCCI bundle, you-re not alone--but surgeons aren't taking the news lying down.

In our May article -New Fusion Bundles Are Headed Your Way, Thanks to Version 12.1,- we reported that version 12.1 of the National Correct Coding Initiative bundles 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) into 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]).

The NCCI bundle indicates that the procedures are mutually exclusive, and therefore, you should not report both a posterolateral fusion and interbody fusion. Append Modifier 59 for Now The North American Spine Society (NASS) is developing an official position, says Matthew J. Twetten, senior manager of Reimbursement and Health Policy at the NASS. In the meantime, spine surgeons tell Neurosurgery Coding Alert that they-ll continue to fight for their separate-procedure payment when they perform these procedures together.

After all, code 22630 (often reported for a posterior lumbar interbody fusion [PLIF] procedure) pays upwards of $1,500, which is a lot of money for surgeons to lose, especially since they can spend more than an hour performing the procedure.

Modifier method: Because the new bundle carries a -1- indicator, surgeons can append a modifier such as 59 (Distinct procedural service) to 22630 if the PLIF is a distinct procedural service. And one surgeon tells us that he intends to do just that when he performs a separately identifiable PLIF with a posterolateral fusion.

-I am vehemently against the new edit,- says Douglas Ehrler, MD, an orthopedic surgeon at the Crystal Clinic in Akron, Ohio. Until the NCCI rectifies the bundle, he intends to append modifier 59 to 22630 and submit a cover letter indicating exactly why he thinks the PLIF or transforaminal lumbar interbody fusion (TLIF) is a separate procedure.

Here's the difference between the procedures: -A posterior lateral fusion [22612] involves laying bone graft in the posterior lateral gutters,- Ehrler says. -That is decortication of the transverse processes, facets, and packing bone in that area. This can be augmented with pedicle screws. This is a standard posterior lateral fusion that has been around in various forms since the advent of spine surgery. It requires only exposing the facets and transverse processes in that area, and packing bone graft in that region.-

A PLIF (22630), on the other hand, is similar to a TLIF, Ehrler says. -The procedure essentially accomplishes a fusion of the anterior and middle columns of the spine (the interbody fusion between the vertebral bodies). The interbody fusion fuses where a disk space is, thus fusing the endplates of the two vertebrae [...]