Neurosurgery Coding Alert

Question: A thoracic surgeon and neurosurgeon work together during arthrodesis for interspaces T6-T7, T7-T8, and T8-T9 using an anterior approach for interbody technique. Additionally, the neurosurgeon packs the interspaces with morselized allograft and places anterior instrumentation with attachment points at T6, T7, T8, and T9. How should I code this procedure?

South Dakota Subscriber

Answer: In this case, both the thoracic surgeon and neurosurgeon will report 22556 (Arthrodesis, anterior  interbody technique, including minimal discectomy to prepare interspace [other than for decompression], thoracic) and append modifier 62 (Two surgeons) for the initial interspace (T6-T7) and +22585-62 x 2 (... each additional interspace [List separately in addition to code for primary procedure]) for the additional interspaces (T7- T8 and T8-T9).

Only the neurosurgeon will report the bone graft (+20930, Allograft for spine surgery only; morselized [List separately in addition to code for primary procedure]) and instrumentation placement (+22846, Anterior nstrumentation; 4 to 7 vertebral segments [List separately in addition to code for primary procedure]) because the thoracic surgeon did not assist in these procedures. (Note, in addition, that CPT instructions prohibit modifier 62 with spinal bone graft and instrumentation procedures).

Remember: When reporting co-surgeries, you should work closely with the other operating surgeons staff to ensure that each practice gets its fair share of the reimbursement. Medicare and most other payers reimburse procedures coded with modifier 62 at 125 percent of the regular fee schedule amount. The payer divides this between the two surgeons reporting the procedure, so each surgeon receives 62.5 percent of the standard fee.

To ensure that both physicians receive proper payment correctly, follow four guidelines:

1. Each physician should document his own operative notes, detailing what portion of the procedure he performed, how much work was involved, and how long the procedure took.

2. Each surgeon should identify the other as co-surgeon.

3. The co-surgeons should link the same diagnosis to the common procedure code.

4. Each physician should submit his own claim with his own documentation, and diligently note both the work he performed and that of the other physician.