Neurosurgery Coding Alert

Question: How should I report decompression by laminectomy at L4/L5, posterior lumbar interbody fusion using Osteotek ramps (cadaver bone), inter-transverse fusion at L4/L5, transpedicular fixation at L4/L5 and posterior iliac crest graft harvest?

Neurosurgery Discussion Group Participant

Answer: You should report 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar) for the L4/L5 interbody fusion and 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) for the inter-transverse fusion with modifier -51 (Multiple procedures) appended to the lower-paying procedure (in this case, 22612).

For pedicle fixation, report instrumentation code 22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation]). The Osteotek ramps are preshaped cadaver implants, similar in function to threaded bone dowels, for which you may claim 22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace). Based on CPT guidelines, do not append modifier -51 to the instrumentation code.

Claim 20937 (Autograft for spine surgery [includes harvesting the graft]; morselized [through separate skin or fascial incision]) for the posterior iliac crest graft. As with the instrumentation codes, modifier -51 does not apply to the graft codes.

Note that decompression 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) is bundled to fusion 22630. You may append modifier -22 (Unusual procedural services) and request additional compensation, but only if there is significant pathology that required additional work well beyond the standard approach for interbody fusion. If you file such a claim, be sure to include sufficient documentation and a separate cover letter requesting increased payment.