Orthopedic Coding Alert

Don’t forget about post-osteotomy arthrodesis.

If a patient reports to your practice needing an osteotomy, coders are going to be challenged if they want the file a clean, complete claim.

Why? There’s a lot of detail in a typical osteotomy claim, including several services you might be able to code for in addition to the primary surgical procedure—provided you know what to look for.

Check out this primer on coding osteotomies for your orthopedic patients.

Know Osteotomy Definition

Spinal osteotomy is a surgical procedure that involves the removal of anatomical structures in the spine, such as the lamina and facet joints, to treat deformity. While it is typically performed as part of deformity correction, osteotomy concurrently results in spinal decompression treatment, which would not be separately reportable. Consequently, one would not report a laminectomy at the same interspace level as an osteotomy.

The purpose of spinal osteotomy is to address conditions such as degenerative spondylolisthesis with moderate to severe lumbar spinal stenosis, kyphosis, or scoliosis.

E/M, Imaging Lead to Osteotomy Decision

Before your surgeon performs an osteotomy, they will need to make a decision for surgery. This is typically done through a combination of services, explains Joseph Kapurch, MD, at Metropolitan Neurosurgery in Coon Rapids, Minnesota.

An evaluation and management (E/M) service and imaging will likely be the first step toward performing an osteotomy. The physician will likely perform an office/outpatient E/M, which you’d code with 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) Be observant, though; the physician might perform another E/M service — such as hospital inpatient or observation — before deciding on the procedure.

Also, standing X-rays and a computed tomography (CT) scan may be necessary, Kapurch says. When a patient needs more than 10 degrees of correction in a sagittal or coronal plane with some amount of fixed alignment — fusion, disk collapse, trauma — an osteotomy may be indicated. “Almost never would it be needed as a primary treatment; all mine [osteotomy patients] have been in previously fused patients or fracture.”

The codes you’ll choose from for X-rays and CT scans for potential osteotomy patients are:

• Spinal X-ray: 72020 (Radiologic examination, spine, single view, specify level) through 72120 (Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views)
• Spinal CT: 72125 (Computed tomography, cervical spine; without contrast material) through 72133 (Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections)

Other Services Are Possible During Osteotomy

You’ll report spinal osteotomies with codes from the 22206 (Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic) through +22226 (Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)) set.

Depending on the situation, there are a host of other surgeries/ services that might accompany an osteotomy. Be on the lookout for these services on your osteotomy encounter forms.

According to Kapurch: “A decompression and fracture reduction are sometimes part of the osteotomy. They are separate but integrated. A patient with nerve compression due to a deformity could benefit partially from a laminectomy/ facetectomy, but the deformity pain and alignment issues would not improve without the additional osteotomy at the same level. Similarly for a fracture, the fracture could be stabilized or partially reduced, but not adequately obtain proper alignment without an osteotomy.”