Wiki 2 primary fusion codes

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sdunaway1

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Hello -

I cannot remember if you are allowed to bill 2 primary fusion codes if the junctions are not continuous. Example L4- L5 and T10-T11 There are 2 opening s and closings of the surgical sites. Would you code this as 22612,22614 OR 22612, 22610?

Thank you!!
 
sdunaway1 said:
Hello -

I cannot remember if you are allowed to bill 2 primary fusion codes if the junctions are not continuous. Example L4- L5 and T10-T11 There are 2 opening s and closings of the surgical sites. Would you code this as 22612,22614 OR 22612, 22610?

Thank you!!
Click to expand...
Zupko advises to use only 1 primary code (I'm looking in the book from one of the conferences we attended in the last few years), BUT the example they use is all 1 incision, T11-S1.
I vaguely remember them stating (but this is not in the book), that if it is separate incisions/noncontinuous segments, that some payers may allow both primary codes.
If I were coding this case, I would attempt both primary codes, with detailed claim line notes that they were performed via separate incisions, with specific levels noted, and attach the op note. They may not go for it....but they might.
 
mhstrauss said:
Zupko advises to use only 1 primary code (I'm looking in the book from one of the conferences we attended in the last few years), BUT the example they use is all 1 incision, T11-S1.
I vaguely remember them stating (but this is not in the book), that if it is separate incisions/noncontinuous segments, that some payers may allow both primary codes.
If I were coding this case, I would attempt both primary codes, with detailed claim line notes that they were performed via separate incisions, with specific levels noted, and attach the op note. They may not go for it....but they might.
Click to expand...
thank you for your input Meagan. That is exactly what I was thinking w the 2 prime codes because there is documentation for each opening and closing. I just cannot find any reference to the non continuous fusion and have that wonder ful AANS book as well .
 
sdunaway1 said:
thank you for your input Meagan. That is exactly what I was thinking w the 2 prime codes because there is documentation for each opening and closing. I just cannot find any reference to the non continuous fusion and have that wonder ful AANS book as well .
Click to expand...
Yea, I really wish we could record any conference or phone call where a consultant or payer gives guidance that clarifies one of the many gray areas... But I guess that would make this all too easy!!
 
The NCCI manual has your info. Don't forget to check there if the payer follows MCR. https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf

"4. Many spinal procedures are grouped into families of codes where there are separate primary procedure codes describing the procedure at a single vertebral level in the cervical, thoracic, or lumbar region of the spine. Within some families of codes, there is an Add-on Code (AOC) for reporting the same procedure at each additional level without specification of the spinal region for the AOC. When multiple procedures from one of these families of codes are performed at contiguous vertebral levels, a provider/supplier shall report only one primary code within the family of codes for one level and shall report additional contiguous levels using the AOC(s) in the family of codes. The reported primary code should be the one corresponding to the spinal region of the first procedure. If multiple procedures from one of these families of codes are performed through separate skin incisions at multiple vertebral levels that are not contiguous and in different regions of the spine, the provider/supplier may report one primary code for each noncontiguous region."
 
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