Neurosurgery Coding Alert

Question: A patient was diagnosed with cervical spondylosis and herniated nucleus pulposus at C5-C6. The neurosurgeon performed an extensive anterior cervical diskectomy at C5-C6, arthrodesis with allograft and anterior Accufix plating. How should I code this?

Maryland Subscriber

Answer: The correct coding, according to Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, would be 63075 (diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace); 22554 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2); 20931 (allograft for spine surgery only; structural) and 22845 (anterior instrumentation; 2 to 3 vertebral segments).

Sandham notes that few payers will reimburse for the allograft and many (including California Medicare and Blue Cross Blue Shield) are rebundling the anterior diskectomy in the fusion. This can often be appealed successfully if nerve decompression or osteophytectomy are documented.