Neurosurgery Coding Alert

Question: The surgeon's documentation specified anterior arthrodesis with diskectomy. I reported 63075 and 22554, but the payer denied 63075. What's the problem?


Maryland Subscriber

Answer: Check the documentation a second time to be sure that the surgeon did, indeed, perform a complete diskectomy (including, for instance, decompression).
 
If you read the descriptor for 22554 (Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2) closely, you'll notice that it contains the phrase "including minimal diskectomy."

Although the National Correct Coding Initiative doesn't specifically bundle 22554 and 63075 (Diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace), many payers keep an eye on such claims so they don't pay separately for a minimal diskectomy that should be included in 22554.

If your surgeon performed minimal diskectomy only, accept the payer's decision to reject 63075, check your documentation more carefully in the future and move on.
 
If, however, the surgeon performed a "more than minimal" diskectomy (such as osteophytectomy, or removal of bone spurs), refile the claim with supporting documentation. Provide evidence of the surgeon's effort during the diskectomy. For instance, explain that the diskectomy was not minimal as described by 22554, and request payment for 63075 in addition to 22554.