Neurosurgery Coding Alert

Question: If the surgeon performs a lumbar spine osteotomy (22214) and places an X-STOP device (0171T), may I report both codes to Medicare?

Massachusetts Subscriber

Answer: The national Correct Coding Initiative (CCI) bundles 0171T into 22214.

Result: You should report only 22214 (Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar) or 0171T (Insertion of posterior spinous process distraction device [including necessary removal of bone or ligament for insertion and imaging guidance], lumbar; single level) for Medicare and other payers who apply CCI edits. If you report the two codes together, Medicare will pay only 22214. Placement of the interspinous distraction device requires cutting the posterior elements (that is, osteotomy or partial excision), which is included in the work of 0171T.

CCI also bundles 0171T into 22102 (Partial excision of posterior vertebral component [e.g., spinous process, lamina or facet] for intrinsic bony lesion, single vertebral segment; lumbar) and lumbar codes such as 22521 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; lumbar) and 63017 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than 2 vertebral segments; lumbar).

-- Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.