Orthopedic Coding Alert

Patients reporting to the surgeon for vertebral corpectomy could create confusion, as there are some puzzling aspects when it comes to coding this procedure.

“For vertebral corpectomy, the term partial is used to describe removal of a substantial portion of the body of the vertebra,” says Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois. “In the cervical spine, the amount of bone removed is defined as at least one-half of the vertebral body. In the thoracic and lumbar spine, the amount of bone removed is defined as at least one-third of the vertebral body.”

If the corpectomy doesn’t meet the criteria for partial as listed above, you might have to use alternate coding avenues like reporting a discectomy (which includes osteophytectomy and bony end plate removal/preparation) or partial excision of a vertebral body for an intrinsic bony lesion. Examples of reportable primary codes when the criteria for corpectomy have not been met include:

• 22110 (Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical) through 22114 (… lumbar)
• 22551 (Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2)
• 63055 (Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; thoracic)
• 63056 (… lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc))
• 63064 (Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single segment)
• 63075 (Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace)

Best bet: Check with your payer to see what it considers the minimum for a corpectomy to be considered partial. If a coder suspects that there may be a documentation deficiency, the surgeon should be queried and the CPT^® criteria for reporting a corpectomy code should be reviewed.

I.D. Approach for Proper Coding

You’ll report most of your vertebral corpectomies with codes from the 63081 (Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment) through +63091 (Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; each additional segment (List separately in addition to code for primary procedure)) code set. This series of codes is applied to degenerative and traumatic conditions of the vertebral body.

You will, however, need information on the type of approach the surgeon used in order to code correctly.

Here’s a rundown of the approaches your surgeon could employ for 63081 through +63091 vertebral corpectomies:

• Anterior/anterolateral: In this approach, the surgeon accesses the vertebra from the front and side—a common approach for spinal surgeries.
• Transthoracic: In this approach, the surgeon makes an incision through the chest wall, usually from the side, to access the surgical site.
• Combined thoracolumbar: In this approach, the surgeon accesses both the thoracic and lumbar regions of the spine by making an incision on the side near the junction of the thoracic and lumbar areas in order to access the diaphragm and thoracolumbar junction.
• Transperitoneal/retroperitoneal: In the transperitoneal approach, the surgeon accesses the surgical site through the anterior abdomen by cutting through the peritoneum. In the retroperitoneal approach, the surgeon accesses structures without entering the peritoneal cavity by dissecting around the outside of the peritoneum.

Use These Codes for Lateral Extracavitary Surgery

Another type of vertebral corpectomy your surgeon might perform is via lateral extracavitary approach. In this approach, the surgeon accesses the surgical site through the back side of the body, but works underneath rather than between the paraspinal muscles.

Report corpectomies via extracavitary approach with codes with one of the following codes, depending on encounter specifics:

• 63101 (Vertebral corpectomy (vertebral body resection), partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root(s) (eg, for tumor or retropulsed bone fragments); thoracic, single segment)
• 63102 (… lumbar, single segment)
• +63103 (… thoracic or lumbar, each additional segment (List separately in addition to code for primary procedure))

Remember Different Corpectomy Codes for Intraspinal Lesions

If the surgeon decides on corpectomy to treat an intraspinal lesion, there’s another set of codes for the occasion, Adams said. These surgeries will all employ the same approaches as the corpectomies discussed above, but they can be performed in two locations: extradural or intradural.

The difference is simple. Extradural means outside the dura mater, and intradural means inside.

When the surgeon removes an extradural intraspinal lesion, report a code from the 63300 (Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical) through 63303 (… extradural, lumbar or sacral by transperitoneal or retroperitoneal approach) set.

For intradural lesion removal, choose a code from the 63304 (… intradural, cervical) through 63307 (… intradural, lumbar or sacral by transperitoneal or retroperitoneal approach) code set.

No matter the location of the spinal lesion, Adams said you’ll use the same code for each additional segment: +63308 (Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; each additional segment (List separately in addition to codes for single segment)).

Look for Instrumentation Opportunities

As Adams noted, “spinal surgery is special; sometimes you can code instrumentation separately.” This is typically the case for corpectomy.

If the surgeon uses instrumentation during corpectomy, choose from 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 +22847 (Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure)) codes based on encounter specifics.

In addition, a structural bone graft or cage is usually reported to fill the defect created after the corpectomy. Choose +20931 (Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)) or +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)) if a structural bone graft is used; or +22854 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)) or +22859 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)) for an intervertebral biomechanical device (with or without arthrodesis, respectively).

Don’t Forget About Arthrodesis

In most circumstances, an arthrodesis will be performed after a corpectomy. Choose the correct code set based on the approach. Remember that after partial or complete removal of a vertebral body, there are typically two interspaces that have been concurrently removed, for which an arthrodesis code should be reported for each intervertebral disc removed.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC