Neurosurgery Coding Alert

When your surgeon treats a patient with osteotomy, coders need to be ready for the challenge of filing a complete claim.

The purpose of spinal osteotomy is to address conditions such as degenerative spondylolisthesis with moderate to severe lumbar spinal stenosis, kyphosis or scoliosis.

Know What Services Could Lead to Osteotomy Decision

Before your surgeon performs an osteotomy, they will need to make a decision for surgery. This is typically done through a combination of services, explains Joseph Kapurch, MD, at Metropolitan Neurosurgery in Coon Rapids, Minnesota.

An evaluation and management (E/M) service and imaging will likely be the first step toward performing an osteotomy. The physician will likely perform an office/outpatient E/M, which you’d code with 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) Be observant, though; the physician might perform another E/M service — such as hospital inpatient or observation — before deciding on the procedure.

Also, standing X-rays and a CT (computed tomography) scan may be necessary, Kapurch says. When a patient needs more than 10 degrees of correction in a sagittal or coronal plane with some amount of fixed alignment — fusion, disk collapse, trauma” — an osteotomy may be indicated. “Almost never would it be needed as a primary treatment; all of mine [osteotomy patients] have been in previously fused patients or fracture.”

The codes you’ll choose from for X-rays and CT scans for potential osteotomy patients are:

• Spinal X-ray: 72020 (Radiologic examination, spine, single view, specify level) through 72120 (Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views)
• Spinal CT: 72125 (Computed tomography, cervical spine; without contrast material) through 72133 (Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections)

Check for Other Services Provided

You’ll report spinal osteotomies with codes from the 22206 (Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic) through +22226 (Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)) set.

Depending on the situation, there are a host of other surgeries/ services that might accompany an osteotomy. Be on the lookout for these services on your osteotomy encounter forms.

According to Kapurch: “A decompression and fracture reduction are sometimes part of the osteotomy. They are separate but integrated. A patient with nerve compression due to a deformity could benefit partially from a laminectomy/ facetectomy but the deformity pain and alignment issues would not improve without the additional osteotomy at the same level. Similarly for a fracture, the fracture could be stabilized/ partially reduced but not adequately obtain proper alignment without an osteotomy.”

Arthrodesis Appears on all Osteotomy Claims

No matter the situation, your surgeon will have to wrap up an osteotomy with arthrodesis to fuse the resected area of the spine. Arthrodesis is typically associated with an osteotomy; “it’s essential to have a fusion at that interspace level,” according to Kapurch.

Report arthrodesis with spinal osteotomy with codes from the 22590 (Arthrodesis, posterior technique, craniocervical (occiput-C2)) through +22632 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (List separately in addition to code for primary procedure)) set.