Neurosurgery Coding Alert

Know how surgeon diagnosed deformity for proper coding.

Patients that require arthrodesis for a spinal deformity present a unique coding challenge.

How? The surgeries have their own code set, separate from the other spinal arthrodesis codes. Also, they have an extensive list of ICD-10 codes that could prove medical necessity for the procedure.

Take a look at this primer on coding for patients who receive arthrodesis due to spinal deformity.

Look to These Evaluation Methods for Pre-Arthrodesis Dx

Before your surgeon performs spinal arthrodesis, they have to decide if the patient has a spinal deformity—and what type of deformity it might be. The surgeon could use a combination of these testing methods to determine the presence of spinal deformity, confirms Judy Wilson, CPC, COC, CPCO, CPPM, CPB, CANPC, CDEO, CPC-P:

• Evaluation and management (E/M) service: Typically 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.)—but there is a chance that the E/M could take place in the hospital, which you’d report with the appropriate inpatient E/M code
• X-ray: 72020(Radiologic examination, spine, single view, specify level) through 72120 (Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views)
• Magnetic resonance imaging (MRI):72141(Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material) through 72158 (Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar)
• Bone scan: 78300 (Bone and/or joint imaging; limited area) through 78315 (… 3 phase study)

E/M and X-ray example: If the surgeon uses a combination of E/M and X-ray, “a specialist will perform a physical examination and order X-rays of the spine. During an exam, the doctor will usually ask the patient to move into a few positions, such as a forward bend, in order to observe the spine as it moves,” according to the American Association of Neurological Surgeons (AANS).

MRI example: When the surgeon uses MRI, they perform the test to “produce three-dimensional images of body structures using powerful magnets and computer technology,” according to Yale Medicine. The MRI “can show the spinal cord, nerve roots and surrounding areas, as well as enlargement, degeneration and deformities.”

Use These Codes for Arthrodesis

When the surgeon does decide to perform arthrodesis for a patient with a spinal deformity, these are the codes you’ll choose from, Wilson confirms:

• 22800 (Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments)
• 22802 (… 7 to 12 vertebral segments)
• 22804 (… 13 or more vertebral segments)
• 22808 (Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments)
• 22810 (… 4 to 7 vertebral segments)
• 22812 (… 8 or more vertebral segments)

Look for These Additional Services on Arthrodesis

It is important to understand that the arthrodesis codes for spinal deformity do not include certain additional procedures that might be performed during the same session. These procedures include:

• Bone graft harvest: +20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)) through +20938 (Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)).
• Anterior or posterior spinal instrumentation: +22840 (Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)) through +22848 (Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure))
• Posterior decompression: 63045 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/ or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical) through +63048 (Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional vertebral segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure))

Also: Preoperative planning with intraoperative neuronavigation may also be performed and would be separately reported with +61783 (Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure)). While intraoperative imaging would be common, this would not be separately reportable with the arthrodesis codes.