Neurosurgery Coding Alert

Question: My surgeon worked with an orthopedic surgeon during removal of anterior spinal instrumentation. Our office and the orthopedic surgeon reported this using 22855-62, and the payer denied the claim. What should we have done differently?

Missouri Subscriber

Answer: Assuming your documentation was complete, you'll want to appeal the claim. 

In 2003, CPT revised the instructional text accompanying the codes in the "Spine (Vertebral Column)" portion (22100-22855) to reflect new surgery guidelines. Specifically, prior versions of CPT instructed, "Do not append modifier '-62' [Two surgeons] to spinal instrumentation codes 22840-22855." For 2003, these instructions changed to state, "Do not append modifier '-62' to spinal instrumentation codes 22840-22848 and 22850-22852." This means that two surgeons may work (and bill) as co-surgeons during reinsertion of spinal fixation device (22849) or removal of anterior instrumentation (22855) as long as they work together as primary surgeons.

Possibly your payer missed these changes in CPT. If necessary, copy the relevant instructions from CPT and send them along with your appeal.