Neurosurgery Coding Alert

Question: Our physician performs anterior cervical diskectomy and fusion (ACDF) surgeries along with anterior cervical plate fixation with the use of a microscope. We submit our claims with the codes in the following order: 22554, 22585, 63075, 63076, 22845, 20931, 69990. Is this correct?

Donna Umberger, Office Manager
Institute for Neurosurgery & Spinal Disorders, P.C. Princeton, W.Va.

Answer: Some of the codes suggested are correct, but others may not be appropriate in all situations where ACDF procedures are concerned. ACDF is a procedure that often is denied or reduced by carriers even when the neurosurgeon codes it properly.

CPT 2000 specifies that minimal diskectomy to prepare [the] interspace is included in the fusion (when, for example, this procedure is performed to correct spinal instability). This language may confuse carriers reviewing anterior cervical diskectomy and fusion claims.

Carriers tend to deny things in the absence of specific proof. In this case, a carrier would require documentation (ideally, an operative report) to clearly prove that the disk removal was not just a minimal diskectomy for fusion preparation but that it actually involved a decompression of nerve roots or removal of posterior osteophytes (bone spurs).

Many carriers have set up computer edits to catch and reject certain coding combinations when claims are billed electronically. These edits cannot determine the extent of the services provided, and consequently, claims that should be paid are not. An edit to monitor ACDF claims often is installed to ensure that a decompression according to CPT 2000 requirements actually occurred.

The coder may have to contact the carrier and speak with either a customer service representative or supervisor to show the decompression and get the claim paid.

When a nerve or canal decompression is performed, a common treatment with the excision of posterior osteophytes, 63075 (diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) is the appropriate code to bill. This code often is denied initially but allowed on appeal, and this actually may be a more efficient process than using the -22 modifier (unusual procedures services) or the often applied but incorrect -59 modifier (distinct procedural service) and hoping for individual consideration at first billing.

Code 69990 (use of operating microscope [list separately in addition to code for primary procedure]) should not be reported with the anterior cervical diskectomy and fusion because CPT 2000 lists 69990 is an inclusive component of code 63075.

Code 20931 (allograft for spine surgery only; structural) would be billed if a structural allograft (i.e., graft not harvested from patient) is used. A structural allograft involves taking a piece of bone from a bone bank and shaping it into a little strut. A groove generally is drilled into the front of the vertebra, in the interspace, and the neurosurgeon taps it into place so that the pressure of the two vertebrae being pressed up against each other holds the graft in place while also providing anterior stability. The allograft code should be used only once no matter how many levels are addressed. Add-on codes are common for this type of procedure, and 20931 often is appended to billings for anterior cervical diskectomy and fusions.