Neurosurgery Coding Alert

Question: May we report the fracture repair codes in addition to a vertebral corpectomy? What about bone grafts and spinal instrumentation?

California Subscriber

Answer: Anterior vertebral corpectomy (63081-63085) involves partial or complete removal of the vertebral body. Such procedures are performed to correct a compressed spinal cord caused by vertebral trauma (such as a fracture), vertebral collapse caused by bone cancer, or other degenerative diseases. The procedure includes diskectomy above and/or below the vertebral body or bodies removed.
 
According to CPT Coding Made Easy: A Technical Guide, when spinal fracture repair is also performed, the vertebral corpectomy is the definitive treatment. Other associated procedures, however, such as arthrodesis (22548-22812) and spinal reconstruction including bone grafts (20930-20938) and spinal instrumentation (22840-22855) are separately payable.
 
CPT specifies that bone graft and instrumentation codes, although not specifically defined as add-on procedures, "are reported in addition to codes for the definitive procedure(s)." Modifier -51 (Multiple procedures) is not appropriate for these procedures. In addition, an operating microscope (69990) may be used during these procedures and may be billed for some non-Medicare payers.
 
As an example: To repair a compressed nerve caused by fracture, diskectomies are performed with the aid of an operating microscope, followed by corpectomy of segments C3 and C4. The compressed nerve roots are freed. Spinal reconstruction is undertaken using tricortical allograft and titanium plates. The session should be reported:

  

63081 Vertebral corpectomy (vertebral body resection), partial or complete,  anterior approach with decompression of spinal cord and/or nerve root(s);    cervical, single segment

 

63082 cervical, each additional segment (list separately in addition to   code for primary procedure)

 

22554 Arthrodesis, anterior interbody technique, including minimal diskectomy   to prepare interspace (other than for decompression); cervical below C2 

 

22585 x 2 each additional interspace (list separately in addition to code for primary procedure)

 

20931 Allograft for spine surgery only; structural

 

22846 Anterior instrumentation; 4 to 7 vertebral segments.
 
In this case two vertebral bodies are removed but arthrodesis occurs across three interspaces, allowing for the additional units of 22585. In addition, instrumentation involves four segments because the fixation will extend above and below the two reconstructed segments.
 
Note: If required by the payer, append modifier -51 to the arthrodesis code (22554).

  Clinical and coding expertise for You Be the Coder and Reader Questions provided by 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.