Neurosurgery Coding Alert

Question: Blue Cross/Blue Shield disallowed CPT code 22558 of the following surgery: 22558 (arthrodesis/lumbar), 22851 (application of prosthetic device) and 22855 (removal of spinal fixation), stating that it was “global” and therefore not allowed per their policy. The carrier crossed off other codes (22851 and 22855), stating that they were not allowed per administrative policy. Would you please let us know if the reduction of these codes is correct?
Cheryl Deahn
Northwest Neurosurgical Associates, Tualatin, Ore.

Answer: There is nothing inherently wrong with this coding, assuming that the operative report supports the different procedures billed. The problem lies with the national Correct Coding Initiative (CCI) edits. Although it is possible to remove a previous spinal fusion and then reconstruct it at the same session and at the same level, current edits bundle the more extensive procedure code 22558 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; lumbar) into the “mutually exclusive” procedure code 22855 (removal of anterior instrumentation), which is the lesser procedure. Further, because the spinal fusion is disallowed, the insertion of prosthesis (22851) also is denied.

If the spinal fusion and reconstruction are done at different levels, it is easy and appropriate to override the edits with the -59 modifier (distinct procedural service). But if these two components were done at the same level, it will be difficult to appeal the claim to gain the medical policy decision needed to ensure reimbursement.

Until such CCI edits are struck, the neurosurgeon is advised to drop code 22855 from the codes billed in this example. Not billing for the removal of the spinal fixation should allow payment for the other two procedures. A case could then be made for billing code 22558 with the -22 modifier (unusual procedural services), thus increasing compensation for the arthrodesis and reflecting the additional work required by the prior fusion removal.