Neurosurgery Coding Alert

Beware:  Modifier 22 may not help you capture additional reimbursement

As of April 1, you can no longer report a posterolateral fusion with an interbody fusion without appending a modifier, thanks to the National Correct Coding Initiative version 12.1 bundling guidelines. Find out how this edit and others may cost your neurosurgery practice money.

22612/22630 Bundle Makes Sense but Is -Unfortunate-

Neurosurgeons commonly perform a posterolateral fusion at the same time as an interbody fusion. Prior to April 1, you could have expected payment for both procedures.
 
Old way: You would have reported both fusion procedures using 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) and 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar). You would have appended modifier 51 (Multiple procedures) to 22630 to indicate that the surgeon performed more than one procedure during the same session.

New way: NCCI now bundles 22630 into 22612, indicating that the procedures are mutually exclusive. The bundle has a modifier indicator of -1,- which means you can break the bundle if you can show that both procedures were distinct and separate.

-The posterolateral fusion is fairly minor when done at the same level as an interbody fusion, so the bundle makes sense,- says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University department of surgery in New York. -But the procedure still adds time, effort and liability, so it's unfortunate that neurosurgeons won't get paid for it anymore.-

For one level, your neurosurgeon may spend an additional half hour for each side, just for extending the exposure to perform the lateral fusion, says Lisa May, CPC, senior charge specialist for Fletcher Allen Health Care in Burlington, Vt. Your surgeon may also need to prepare the recipient site and place the bone graft, which adds additional work, time and risk, she says.

Modifier 22 Is Your Best Bet

To capture payment for the neurosurgeon's extra time and work, use a modifier when the documentation reflects both fusion procedures. Unfortunately, using a modifier may not guarantee you-ll see reimbursement on both.

May plans to encourage the surgeons in her group to make sure their documentation supports the additional work involved with the interbody fusion to perform the lateral fusion, including documentation of time. She-ll then report both 22612 and 22630, appending modifier 22 (Unusual procedural services) to 22630.

-Either way, our reimbursements will suffer, as we haven't had any trouble with getting the two of these paid in the past when performed together, and using the 22 modifier rarely generates additional payment for us,- May says.