Neurosurgery Coding Alert

Question: We are billing a Medicare patient for "ACDIF & reconstruction requiring C3-C7 anterior cervical discectomies, decompression, partial corpectectomy, and titanium anterior plating."  Is the following code selection appropriate? Please suggest.

• 63081 (Vertebral corpectomy [vertebral body resection], partial or complete, anterior approach with decompression of spinal cord and/or nerve root[s]; cervical, single segment) x3
• 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2)
• 22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; each additional interspace [List separately in addition to code for primary procedure]) x3
• 22846 (Anterior instrumentation; 4 to 7 vertebral segments [List separately in addition to code for primary procedure])
• 20931 (Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)
• Diagnosis codes: 721.1 (Cervical spondylosis with myelopathy), 723.4 (Brachial neuritis or radiculitis nos), 722.4 (Degeneration of cervical intervertebral disc), 721.8 (Other allied disorders of spine).

Does Medicare allow 22554 with 63081? Please help.

Minnesota Subscriber

Answer: In order to bill a corpectomy, you must document at least 50 precent removal of the vertebral body for the cervical spine to report 63081 for the first vertebral body, and 63082 for each additional vertebral body. Moreover, a corpectomy includes discectomies above and below.  

For 2012, interspace decompression by discectomy and arthrodesis are reported with the combined code 22551 for the first interspace level and 22552 for each additional interspace level.

If an interbody allograft or prosthetic devices are used at each interspace, it is unlikely that a corpectomy was performed. The combined code 22551 includes the discectomy, osteophytectomy, and bone removal from the vertebral bodies in order to adequately decompress the spinal cord and/or nerve roots at the interspace. A review of the operative note and perhaps postoperative imaging would be required to determine whether a corpectomy was actually performed.