NCCI News:
Don't Expect Payment for Interbody Fusion With Posterolateral Fusion
Published on Sun Apr 02, 2006
Version 12.1 focuses on knee, spine and debridement claims
If you have regularly reported 22612 and 22630 together, brace yourself: The latest round of National Correct Coding Initiative edits, which became effective on April 1, makes it clear that you shouldn't report them separately unless you perform a distinct procedural service. Fusion Code Pairs Take a Hit If your surgeon performs a posterolateral fusion at the same time he performs an interbody fusion, you could have trouble collecting for the interbody procedure.
Old way: In the past, you probably reported the fusion procedures with 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) and 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar).
New way: NCCI now bundles 22630 into 22612 as -mutually exclusive procedures,- but you can use a modifier to separate the edit if the surgeon performs distinct procedural services.
But spine surgeons aren't taking the news sitting down, because the interbody fusion can sometimes take well over an hour, and therefore they expect to get paid for it. In some instances, spine surgeons find it clinically necessary to perform both procedures. For instance, many surgeons customarily supplement a PLIF or TLIF with a posterior fusion.
What you can do: Spine coders should contact their local and national associations to ask how they can effect change to eliminate this new edit. Beware What You Report With 27415 The NCCI version 12.1 now bundles several orthopedic codes into 27415 (Osteochondral allograft, knee, open). For instance, knee arthroscopy codes 29866-29867, 29870, 29874 and 29877 are now all bundled into 27415.
Rationale: -Allograft refers to tissue obtained from another source, while autograft is the term for tissue obtained from the patient,- says Paul Kosmatka, MD, an orthopedic surgeon at SMDC Orthopedics in Duluth, Minn. Arthroscopy is not part of the procedure described by 27415, he says, but if the surgeon does perform arthroscopy, -it is considered insignificant and therefore bundled into code 27415.-
Caveat: If the surgeon performs a distinct and separate service along with the allograft, he can append a modifier, such as 59 (Distinct procedural service), to the arthroscopy code. For example, if the surgeon treats a meniscal lesion in a separate compartment from where he implants the allograft, he can append modifier 59 to the meniscal lesion treatment code, Kosmatka says.
The new edition of NCCI also bundles the following codes into 27415:
- Debridement codes 11010-11012
- Major joint/bursa injection code 20610
- Deep implant removal code 20680
- Knee arthrotomy with foreign-body removal, exploration or drainage code 27310
- Knee arthrotomy codes 27330-27331
- Partial bone excision code 27360
- Knee joint manipulation code 27570.
Spine Edits Shouldn't Shock The NCCI debuted [...]
