Part B Insider (Multispecialty) Coding Alert

Key: Append modifier 51 to removal/reinsertion codes

If you think you can't bill instrumentation removal during repeat infusions, think again. Here's the skinny on which removal/insertion codes you can use with 22830.

Scenario: Your surgeon places segmental instrumentation during a spinal infusion, but one year later, the patient returns complaining of severe low back pain, and the surgeon suspects pseudoarthrosis.

The surgeon returns the patient to the operating room (OR), removes the instrumentation and explores the fusion mass (22830, Exploration of spinal fusion). The orthopedic surgeon confirms pseudoarthrosis and performs a redo fusion.

"Some Medicare carriers say you can't use the instrumentation removal codes with 22830," said Greg Przybylski, MD, professor and director of neurosurgery at the NJ Neuroscience Institute at JFK Medical Center and Seton Hall University at a May 2005 Coding Institute audioconference titled, "Eight Stellar Strategies for Spine Surgery Pay-up."

Those Medicare payors are wrong, Przybylski says. "CPT added language last year that states the American Medical Association's (AMA) position, which is that you can use the instrumentation removal/reinsertion codes with 22830." The applicable removal/ reinsertion codes you should report are:

• 22849--Reinsertion of spinal fixation device
• 22850--Removal of posterior nonsegmental instrumentation (e.g., Harrington rod)
• 22852--Removal of posterior segmental instrumentation
• 22855--Removal of anterior instrumentation.

Reason: CPT states, "Report modifier 51 (Multiple procedures) with 22849, 22850, 22852 and 22855 when instrumentation reinsertion or removal is reported with other definitive procedures such as arthrodesis, decompression and exploration of fusion."

If your insurer continues to deny your instrumentation removal claims when you report spinal fusion, copy the applicable CPT page (the notation is printed directly above code 22830's descriptor) and send it with your appeal, along with a short letter from the surgeon.