Neurosurgery Coding Alert

Question: I am telling a provider that we can't bill a corpectomy (63090) to prepare the interspace for a cage in an ALIF [anterior lumbar interbody fusion]. They are asking why CPT says you can bill fusion, 22558 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than decompression]; lumbar) with 63090. All my research leads me to the conclusion that a corpectomy is a primary procedure and shouldn't be reported for any other reason, other than to decompress. How should I respond?

Pennsylvania Subscriber

Answer: You would need to determine if the surgeon performed decompression that involved a corpectomy. If not, the definition of the service should be enough to tell the provider the corpectomy (63090,Vertebral corpectomy [vertebral body resection], partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment) cannot be done without decompression involving significant or complete vertebral body removal. An ALIF procedure is performed through the disc space, and the preparation of that disc space is included in the arthrodesis code 22558. It would be very unusual to concurrently perform an anterior interspace decompression of nerve roots. If this were done, then the unlisted code 64999 (Unlisted procedure, nervous system) would be needed to describe the decompression.

To bill for a typical ALIF procedure, you would report:

• 22558 -- Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar
• + 22851 -- Application of intervertebral biomechanical device(s) (e.g., synthetic cage[s], threaded bone dowel[s], methylmethacrylae) to vertebral defect or interspace (list separately in addition to code for primary procedure)
• +20930 -- Allograft for spine surgery only; morselized (list separately in addition to code for primary procedure)

Keep in mind: The actual code choices would vary depending on the type of grafting performed, whether a prosthetic or bone

allograft is used for the interbody arthrodesis, and whether anterior plate fixation is performed.