Neurosurgery Coding Alert

Question: The neurosurgeon performed an anterior cervical diskectomy and fusion (ACDF) at C5-6. The diagnosis is herniated nucleosis pulposus at C5-6. Which of the two following coding scenarios is correct: 63075 and 22554-51, or 22554 and 63075-51?

Arizona Subscriber

Answer: The code with the higher relative value unit (RVU) should be billed as the primary procedure, and modifier -51 (multiple procedures) should be appended to the second code. The current Medicare RVU for 63075 (diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) is 36.64. This is higher than the 35.73 for 22554 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2). Therefore, when dealing with a carrier using these RVUs, 63075 should be billed first.

When billing third-party payers, it is crucial to learn if they are using up-to-date RVU data. Non-Medicare carriers are not obligated to stay current with Medicares fee schedule. Many workers compensation and Blue Cross Blue Shield carriers are at least a year behind. Contact your local non-Medicare carriers and ask if up-to-date data are being used so that the amount you are billing is correct. For example, if a carrier is using 1998 RVU data, bill accordingly. Otherwise, you may experience pended or reduced claims, or receive overpayments that will have to be refunded in the event of an audit or internal review.

Note: To access the fee schedule, go to the HCFA Web site, pufiles.htm. Scroll to Payment Rates Noninstitutional Providers and find the bullet labeled National Physician Fee Schedule Relative Value File. Files containing RVU information from 1998 to the present may be downloaded from this section. The one containing the most current data is RVU01.EXE. Scroll to the bottom of the page to accept the CPT copyright statement. To download the CY 2001 file and obtain a self-extracting copy, click the file, accept, and select the directory to which you want to save and click save. When the download is complete, go to the proper directory and double click the saved file. You will be asked to select a directory for the self-extracted files. Choose the directory and click unzip. A total of seven files (comprising four documents, each of which is offered in two or more formats) will self-extract to the chosen directory.