Neurosurgery Coding Alert

Question: The surgeon removed an osteophyte from the cervical spine that was compressing the hypopharynx. He then decompressed the hypopharynx. He reasoned that the procedure was about the same level of difficulty as cervical diskectomy, but without the fusion. How should I code this?

Washington Subscriber

Answer: CPT doesn't contain a specific code for the procedure you describe, although several approximate it. The codes for spinal excision (22100-22116) seem close, but an osteophyte is not an "intrinsic bony lesion," such as a tumor, because osteophytes are on the bone rather than in it. Likewise, spinal osteotomy (22210-22226) generally involves cutting into the vertebral body (for example, for realignment), which is not happening in this case. Anterior diskectomy codes (63075-63076) include osteophy-tectomy, although in this instance the surgeon did not perform a diskectomy. Nevertheless, you may choose to report 63075 (Diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) appended with modifier -52 (Reduced services). Documentation should note that the physician completed the approach, osteophytectomy and closure but without diskectomy.

The safest and perhaps best choice is to use an unlisted-procedure code (22899, Unlisted procedure, spine). CPT guidelines encourage the use of unlisted-procedure codes over selection of the "next best" code when a dedicated CPT code does not describe the procedure performed. Be sure to include full documentation (including an operative report) so the payer can evaluate the claim and determine payment. A separate cover letter describing the effort involved and comparing the procedure to another procedure of similar difficulty (as the surgeon in this case compared the procedure to cervical diskectomy) will aid the payer in deciding on reimbursement.