Orthopedic Coding Alert

Remember to bill multiple codes when surgeon performs ACDF If your surgeon performs an extensive diskectomy with decompression (63075) during his ACDF surgery but fails to document that he performed the diskectomy to decompress the spinal cord and/or the nerve roots, you could forfeit more than $1,000 - the amount that Medicare allots for the anterior diskectomy that goes over and above what CPT 22554 already includes for the arthrodesis.
 
To collect for your orthopedic surgeon's anterior cervical diskectomy with fusion (ACDF), make sure the documentation distinguishes between a minimal diskectomy to prepare the interspace for fusion, and diskectomy with decompression as required for ACDF.

Identify ACDF: ACDF consists of three basic steps, says Kee D. Kim, MD, associate professor at the University of California, Davis in Sacramento.
 
1. The surgeon approaches the cervical spine through an incision in the front of the neck to remove disks and/or bone spurs that may be compressing the spinal cord and/or nerve root (diskectomy with decompression). The orthopedic surgeon typically removes bone from around the area of the excised disk and then,
 
2. places bone grafts to stabilize the spine,
 
3. fuses the adjacent vertebrae, often also using titanium plating (instrumentation), and may insert caging.

If You Claim Diskectomy, Document the Reason When you report arthrodesis (22554, Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2 [fusion]) and diskectomy (63075, Diskectomy, anterior, with decompression of spinal cord and/or nerve root[s], including osteophytectomy; cervical, single interspace) during the same operative session, you must indicate that the surgeon performed diskectomy to decompress the spinal cord and/or the nerve roots.
 
Insurers often reduce or deny claims for 63075 during ACDF because the descriptor for 22554 specifically includes minimal diskectomy to prepare the interspace. Therefore, your documentation must clearly support 63075 by describing the orthopedist's decompression of the neural elements and removal of 1) any fibrovascular scar tissue over the dura, 2) any disk material on the far lateral sides, and 3) any osteophytes (bone spurs) that may be present.
 
Appeal if you have to: If your insurer denies a properly documented diskectomy with decompression (63075) and fusion (22554), be sure to contact the payer and explain that the services are distinct and deserve separate payment. Many carriers have set up computer edits to catch and reject certain coding combinations. These edits cannot determine the extent of the services the surgeon provided, and, consequently, some legitimate claims (including many ACDF claims) are rejected. Turn to 22585 and 63076 for Additional Levels If the orthopedic surgeon performs fusion and/or diskectomy at more than one interspace, you should account for the additional level by reporting add-on codes +22585 (Arthrodesis ...; each additional interspace [list separately in addition [...]