Neurosurgery Coding Alert

Prep with research, as corpectomy comes with slew of codes.

When your neurosurgeon performs corpectomy for a patient, the coding’s not typically cut and dried.

First, you’ll have to decide which type of corpectomy your surgeon performed, as the code family you settle on depends on this decision. There are anatomical considerations after you’ve chosen the specific type of corpectomy. This could get confusing fast without the right guidance.

During her HEALTHCON 2022 session “Coding for Spine Procedures,” Deni Adams, CPC, CPB, CPPM, CEMC, broke down the differences among the corpectomy code families so you can file clean claims the first time.

Know the Types of Corpectomy

There are four types of corpectomy your provider is likely to perform, Adams explained. In the following paragraphs, we’ll get into the specifics of each type.

Anterior/anterolateral: This corpectomy type occurs when the provider excises (removes) part or all of a vertebra via a frontal (anterior) approach and decompresses the spinal cord and/or nerve roots at a single level in the spine, according to Codify by AAPC.

Depending on anatomy (cervical, thoracic, lumbar, lower thoracic, sacral) and number of segments treated, code with 63081 (Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment) through +63091 (… each additional segment (List separately in addition to code for primary procedure)) says Adams.

Lateral extracavitary: This corpectomy type occurs when “the provider removes part of or an entire … vertebral bone and intervertebral disc material in a procedure called a corpectomy. In this procedure, a lateral extracavitary, or LECA, approach is made to one … vertebra to relieve pressure on the spinal cord and spinal nerves,” reports Codify. This surgical approach is uncommonly performed with lateral access to the vertebra achieved through a posterior midline incision and extensive dissection of the paraspinal muscles required to attain a lateral view of the spine.

Depending on anatomy (thoracic, lumbar) and number of segments treated, code with 63101 (Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/ or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic, single segment) through +63103 (… thoracic or lumbar, each additional segment (List separately in addition to code for primary procedure)).

Extradural: This corpectomy type occurs when “the provider performs a partial or complete excision of the main body of a single vertebra, one of the interlocking bones of the back, to remove an extradural lesion within the … spine,” according to Codify.

Depending on anatomy (cervical, thoracic, lumbar, sacral), surgical approach, and number of segments treated, you’ll code with 63300 (Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical) through 63303 (… extradural, lumbar or sacral by transperitoneal or retroperitoneal approach). You’ll use +63308 (Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (List separately in addition to codes for single segment)) for any additional segments in the same anatomical area that the surgeon treats, said Adams.

Intradural: This corpectomy type occurs when “the provider performs a partial or complete excision of the main body of a single vertebra, one of the interlocking bones of the back, to remove an intradural lesion within the … spine,” Codify reports.

Depending on anatomy (cervical, thoracic, lumbar, sacral), surgical approach, and number of segments treated, you’ll code with 63304 (Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; intradural, cervical) through +63308 (… each additional segment (List separately in addition to codes for single segment)).

Regardless of which type of corpectomy approach is used, there are several common factors applicable to all four types.

First, the partial or complete corpectomy includes the excision of the intervertebral disc above and below the vertebral body being removed, and therefore additional codes to report discectomy of the disc attached to the vertebral body being removed are not separately reportable. Second, in the cervical spine at least half of the volume (not cross-sectional area) of the cervical vertebral body needs to be removed to report a partial corpectomy.

In contrast, at least one-third of the volume of the thoracic or lumbar vertebral body needs to be removed to report a partial corpectomy.

Co-Surgeons Often Tackle Corpectomies

Corpectomies are sometimes performed with two surgeons in tandem; in fact, there is a paragraph that tells coders how to handle co-surgery situations in the introduction to the code set: Excision, Anterior or Anterolateral Approach, Intraspinal Lesion.

“For the following codes, when two surgeons work in together … each surgeon should report his/her distinct operative work by appending modifier 62 [Two surgeons] to the single definitive procedure code,” according to CPT^® 2022. The code book also reports that you can append modifier 62 to any of the codes in the 63300 through +63308, “as long as both surgeons continue to work together as primary surgeons.”

The co-surgery modifier would be applicable to the primary procedure where two surgeons work together as primary surgeons, each performing a portion of the corpectomy procedure (usually one performs the approach and the other performs the definitive resection). CPT^® allows for appending modifier 62 to the associated additional level procedures are well when a multilevel corpectomy is performed.