Neurosurgery Coding Alert

Learn when you should appeal multiple-procedure discounts If you don't know which spine surgery procedure codes are modifier 51 exempt and when it's appropriate to report spinal instrumentation removals, you could be losing up to $703 per patient. Now you can be sure you are reporting all the correct codes with the following spinal coding tips. When Should We Use Modifier 51? Question: Our surgeon told me that we shouldn't have to take a multiple-procedure discount on any of our spine surgery claims because these procedures are all modifier 51 exempt. He wants me to stop using modifier 51 (Multiple procedures) on all spinal claims, and to appeal the claims on which the Medicare payers took a multiple- procedure reduction. Is he correct? Answer: No. Some spinal surgery codes are modifier 51 exempt, while others require modifier 51 and will therefore reduce your pay. For example, if you perform a laminectomy with instrumentation, you don't need to append modifier 51 to the instrumentation codes (22840-22848, 22851). -Instrumentation is modifier 51 exempt,- says Matthew Twetten, manager of health policy and reimbursement at the North American Spine Society (NASS).

CPT follows a similar rule for add-on codes, which are also modifier 51 exempt. If the surgeon performs corpectomy at all levels from C2 to C5, you would report 63081 (Vertebral corpectomy [vertebral body resection], partial or complete, anterior approach with decompression of spinal cord and/or nerve root[s]; cervical, single segment) for vertebral segment C2 and three units of +63082 (- cervical, each additional segment [list separately in addition to code for primary procedure]) for segments C3, C4 and C5.
 
Rationale: Insurers make add-on codes (such as 63308) and instrumentation codes modifier 51 exempt because you can never perform them independently of a primary procedure. Therefore, the relative value units (RVUs) for these codes already include multiple-procedure deductions.
 
But if you perform two primary procedures (such as fusion and laminectomy) together, most insurers will take a multiple-procedure reduction on the second procedure.
 
If your insurer specifically instructs you in writing to do so, you may be able to report multiple spine surgery codes together without appending modifier 51, says Susan Posten, CPC, coder at the Houston Center for Spinal Reconstruction and Disc Replacement. Some insurers will add modifier 51 on their own when needed, so you may risk a double discount if you add the modifier when billing those payers.
 
Bottom line: Check your insurers- policies and withhold modifier 51 only when payers instruct you in writing to do so. Many payers -- including most Medicare carriers -- don't want you to use modifier 51.
 
The payer will automatically sort the procedures on your claim in order from highest to lowest RVUs. The payer will pay the [...]