Orthopedic Coding Alert

" When you comprehend the large number and complexity of terms associated with spinal anatomy, disorders and surgical procedures, coding for spinal reconstruction surgery becomes less daunting. Consequently, you will leave less reimbursement on the table. A coder unfamiliar with spine procedures may be baffled by an operative report that reads, laminectomy" L4-5 foraminotomies L4 L5 S1 posterolateral fusion with pedicle fixation L4-5 left iliac crest bone graft." An understanding of these terms can make the spinal coding process a surmountable challenge. Coding Spinal Reconstruction Procedures Among the most complicated of an already complex subspecialty spinal reconstruction procedures are used to correct injuries to the spine caused by external factors (falls accidents etc.) and degenerative or deformative diseases such as scoliosis or degenerative disc disease. These procedures involve the use of fusion instrumentation or cages.

Codes 22548- 22899 describe reconstructive surgeries to the spine. The procedures are often performed in combination with one another which is always the case when instrumentation or cages are inserted. The code descriptions often include the surgical approach either posterior anterior or posterolateral. In posterior approach surgeries the incision is made in the patient's back. In an anterior approach the incision is made in the abdomen or neck and the surgeon moves organs and viscera to reach the operative site on the anterior or front of the spine. In a posterolateral approach the patient lies on his side and the surgeon accesses the operative site from the back. When and How to Report Arthrodesis Also referred to as spinal fusion arthrodesis involves removing corrupt vertebra and disk material and replacing it with bone graft or instrumentation to stabilize the spine. It is often performed in combination with other spine procedures and can be approached from the anterior posterior posterolateral or lateral transverse positions. Fusion can be required for several reasons: to treat a vertebral fracture to correct degenerative conditions or to correct deformity from scoliosis or kyphosis. Codes 22554-22558 (Arthrodesis anterior interbody technique including minimal diskectomy to prepare interspace [other than for decompression ]) are for anterior fusions or arthrodesis at the cervical level below C2 thoracic and lumbar levels and +22585 ( each additional interspace [list separately in addition to code for primary procedure]) is the add-on code for each additional interspace(s). Code 22548 (Arthrodesis anterior transoral or extraoral technique clivus-C1-C2 [atlas-axis] with or without excision of odontoid process) is different from the other anterior fusion codes in that rather than approach the surgical site through an incision in the neck or trunk the surgeon approaches orally or through the patient's mouth. Obviously this code is only for surgeries to the cervical area.

Anterior fusions are often the work of two primary surgeons. One [...]