Orthopedic Coding Alert

There’s a slew of surgeries orthos can perform.

If conservative treatments for a patient with confirmed spinal stenosis fail, there’s a chance that surgery could treat the condition more effectively.

“Surgery could be a variety of procedures, such as percutaneous image guided lumbar decompression, lumbar laminectomy, cervical laminectomy, laminotomy, laminoplasty and others,” explains Cynthia A. Swanson RN, CPC, CEMC, CHC, CPMA, AAPC ICD-10-CM Proficient, AAPC Fellow, senior manager of healthcare consulting at Seim Johnson, LLP in Omaha, Nebraska.

Check out these best practices for coding spinal stenosis surgeries.

Look at This List of Possible Stenosis Surgeries

Remember, what follows is a list and analysis of some of the surgical means that your provider might employ to treat spinal stenosis. It is not meant to be an exhaustive list, and you should check with your payer if you have any doubt about coding for your provider’s surgical services.

“Regarding surgical procedures performed to treat spinal stenosis, the following codes come into play,” explains Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey.:

Cervical Laminectomy

63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; 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 segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)).

On laminectomies, be on the lookout for add-on code opportunities for additional segments, if the orthopedist treats them.

Cervical Arthrodesis

22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment), 22551 (Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2), and 22554 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2).

There are also add-on coding opportunities if the orthopedist treats additional interspaces.

Surgery With Instrumentation

When instrumentation comes into play, you’ll probably be looking at the +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) ) add-on code set, Stout says.

You might also find yourself using +22853 (Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)) or +22845 (Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)) for surgery with instrumentation.

Remember that all of these are add-on codes; never report them without the correct corresponding code for the primary procedure.

Total Disc Arthroplasty

The surgeon might perform arthroplasty, such as 22856 (Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical) on a patient with spinal stenosis.

Lumbar Laminectomy

The orthopedist might use laminectomy, which you’d most likely code with 63047 (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; lumbar) and +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 segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)).

Lumbar Arthrodesis/Allograft

If the orthopedist uses arthrodesis or allograft to treat the stenosis, you’ll likely report code(s) from 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)) through +22614 (Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)) for arthrodesis.

Also, you’ll want to know about 20930 (Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)) through +20939 (Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure))  for surgeries involving bone grafts.

Just a few more: Stout explains if disc disease is also present, you might report 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar) or +22634 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure)) for spinal stenosis patients.

When you use these codes, you might be pairing them with +22853 (Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)), says Stout.

Include Conservative Tx Attempts to Justify Surgery

When you are filing a claim for a surgical spinal stenosis treatment, you should include evidence of prior, more conservative treatments before opting for surgery.

“Many insurance carriers have policies that require a time frame of conservative treatment  prior to surgery,” says Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at

Healthcare Information Services in Park Ridge, Illinois.

“By statute, Medicare may only pay for items and services that are ‘reasonable and necessary’ for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, unless there is another statutory authorization for payment,” explains Cynthia A. Swanson RN, CPC, CEMC, CHC, CPMA, AAPC ICD-10-CM Proficient, AAPC Fellow, senior manager of healthcare consulting at Seim Johnson, LLP in Omaha, Nebraska.

“Documentation should routinely support treatment modalities the patient has tried, response to treatment and the medical indications for surgery,” concludes Swanson.