Neurosurgery Coding Alert

Question: If my surgeon performs extensive discectomy during anterior interbody arthrodesis (for example, 22554), may I report 63075 separately? The descriptor for 22554 specifies "including minimal discectomy," but my surgeon insists that the discectomy he performed in this case (which involved osteophytectomy) was far beyond that required for the arthrodesis and fusion alone. Would simply reporting 22554 with modifier 22 be a better choice than reporting 63075 separately? California Subscriber Answer: Some insurers reduce or deny claims for discectomy, including 63075 (Discectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace), with arthrodesis procedures (such as, in this case, 22554, Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2). The reason for this, as you note, is that CPT includes the phrase "including minimal discectomy" in the descriptors for anterior interbody arthrodesis codes 22554-22558. Payers naturally reason that the discectomy (63075) is not separately payable with the arthrodesis (22554). But, as your surgeon argues, when the surgeon must, for medically justifiable reasons, perform a "more than" minimal discectomy -- that is, a discectomy that is more extensive than that usually associated with arthrodesis -- you may report the discectomy separately. To support your claim, the surgeon's documentation must clearly describe the extensive discectomy by highlighting the surgeon's decompression of the neural elements and removal of 1. any fibrovascular scar tissue over the dura, for instance, the posterior longitudinal ligament; 2. any disc material on the far lateral sides, with foraminotomy; and/or 3. any osteophytes (bone spurs) that may be present. To support your coding further, you should append modifier 59 (Distinct procedural service) to 63075 to differentiate it from 22554. You should also link a separate diagnosis to 63075. Appeal if you have to: If you receive a rejection for a properly documented discectomy with decompression (63075) and fusion (22554), be sure to contact the payer and explain that the services are distinct and deserve separate payment. Many carriers have set up computer edits to catch and reject certain coding combinations. These edits cannot determine the extent of the services the surgeon provided, and consequently, some legitimate claims (including many ACDF claims) are rejected. If you think that the surgeon's documentation doesn't support a separate discectomy code, but the surgeon nevertheless documents significant additional effort and/or time to prepare the interspace, you may attempt to append modifier 22 (Increased procedural services) to 22554. -- 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.