Neurosurgery Coding Alert

" Anterior cervical diskectomy with fusion (ACDF) can be a challenge to code correctly because it involves multiple CPT codes that must often be in a specific sequence when submitting a claim. For some payers, failure to list the codes appropriately could lead to reduced reimbursement. By applying the rules that govern multiple procedures, including the application of modifier -51 (multiple procedures), practices can ethically maximize payment for ACDF and other multicode surgeries.
Step One: Choose the Correct Codes
Up to five codes may be appropriate, as follows:

22554 arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C2

22585 each additional interspace (list separately in addition to code for primary procedure)

63075 diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace

63076 each additional interspace (list separately in addition to code for primary procedure)

20931 allograft for spine surgery only; structural

20938 structural, bicortical or tricortical through separate skin or
fascial incision.
During the procedure, the surgeon enters through the back of the neck to access the spine, removes a disk, grafts in bone harvested from the patient's body or a bone bank, and resupports the neck. In most cases, five of the above codes are used to report the surgery and, depending on the number of spinal levels fused, several codes may be billed more than once (see below for examples).
Step Two: Compare RVUs
When you report multiple-procedure surgeries, individual codes should not be listed on the claim form in numerical order or in the order the procedures were performed or listed on the operative note. They should be listed according to their assigned relative value units (RVUs).
 
Multiple-procedure claims are never paid at 100 percent. Instead, the payer reasons that many of the component services"" that make up the physician's total effort when performing a particular service" such as any inherent E/M or the surgical approach and closure are already paid as part of the primary procedure and do not require separate reimbursement. In other words the multiple-procedure reduction is the payers' way of avoiding redundant charges for shared work under two or more codes.
 
In the past some payers reimbursed 100 percent for the initial CPT procedure listed 50 percent for the second and 25 percent for the third and all subsequent procedures. Since Jan. 1 1995 however payment for the second through fifth procedures has been fixed at 50 percent of the total allowable RVUs for the code with the primary procedure paid in full.
 
This is important because if the primary (i.e. highest- valued) procedure is not listed first a lower-paying code may be fully reimbursed while the primary procedure is [...]