Neurosurgery Coding Alert

Question: Recently, our neurosurgeon performed an exploration of a spinal fusion and then had to remove the instrumentation because the screws were coming loose. That section of the spine then had to be re-fused. We billed for the exploration, removal and re-fusing but were only paid for the exploration. Can you please explain why this happened?

Pennsylvania Subscriber

Answer: This billing problem comes from the Correct Coding Initiatives (CCI) edit of code 22830 (exploration of spinal fusion), states 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, a coder who specializes in surgical and neurosurgical procedures. This coding bundle includes almost every type of fusion procedure as well as lumbar laminectomies. As a result, these codes cannot be billed together. This creates a problem because 22830 has a lesser relative value unit and thus pays substantially less than more comprehensive procedures that are bundled into it.

When a neurosurgeon removes or takes down a fusion and then re-fuses the particular interspace, the neurosurgeon ends up performing a fairly complex procedure and getting reimbursed less than what is deserved because of the CCI edit when 22830 is billed. The exploration of a fusion actually can be a range of services from just going in and looking to see if the fusion has bonded to the rest of the bone, to the other extreme in which the neurosurgeon is actually removing the whole bony firmament.

Sandham recommends that if the neurosurgeon has done a removal of a fusion with the removal of an instrumentation and a repeat fusion during the same operative session, code 22830 should not be billed. If the neurosurgeon explores a fusion on one level and performs a fusion on another level, the -59 modifier (distinct procedural service) can be added to the fusion code so that the insurance carrier will know that these procedures were done on different levels and should not be bundled together.