Orthopedic Coding Alert

Question: Our orthopedic surgeon performed a bilateral hemilaminectomy with diskectomy and foraminotomy for nerve decompression. He then performed a lumbar decompression with posterior lumbar interbody fusion and posterior lateral transverse fusion with pedicular screws. How should I report this?


Tennessee Subscriber

 
Answer: First, you shouldn't consider the hemilaminectomy with decompression part of the fusion (although more payers are beginning to bundle these procedures). Report 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]) for this part of the surgery. Be sure to append modifier 50 (Bilateral procedure) to indicate that the hemilaminectomy was bilateral.

Next, report the posterior lumbar interbody fusion (PLIF), in which the vertebral endplates are separated and graft material inserted between them, using 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar). 

Report the posterior lateral transverse fusion using 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]). Attach modifier 51 (Multiple procedures) to 22612 since your physician performed both the PLIF and posterior lateral transverse fusion.

Remember: You need to report the instrumentation as well. If the orthopedic surgeon performed a single-level instrumentation (i.e., two adjacent vertebrae), you should assign 22840 (Posterior non-segmental instrumentation [e.g., Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation]).

If he performed a two-level (i.e., three-segment) instrumentation attached at L4, L5 and S1, use 22842 (Posterior segmental instrumentation [e.g., pedicle fixation, dual rods with multiple hooks and subliminal wires]; 3 to 6 vertebral segments).

If he placed the pedicle screws and attached the instrumentation at only two places, 22840 would be correct regardless of how many levels are between the endpoints.