janet@drlb.net
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Can someone please clarify the following guideline from the CCI Policy Manual?
"1. Exploration of the surgical field is a standard surgical practice. Physicians shall not report a HCPCS/CPT code describing exploration of a surgical field with another HCPCS/CPT code describing a procedure in that surgical field. For example, CPT code 22830 describes exploration of a spinal fusion. CPT code 22830 shall not be reported with another procedure of the spine in the same anatomic area. However, if the spinal fusion exploration is performed in a different anatomic area than another spinal procedure, CPT code 22830 may be reported separately with modifier 59."
What is considered to be a "different anatomical area"? I'm assuming that If the physician does an exploration and hardware removal at L1-L2, and then does a laminectomy (63047) at L2-L3 via the same incision, both the exploration and hardware removal are bundled into the laminectomy? And that a different spinal level is NOT a "different anatomical area"?
Is it only separately billable if it is performed with a separate incision, into a different spinal area, such as cervical or thoracic?
Is there any documentation that specifically addresses this?
Thank you for your consideration!
"1. Exploration of the surgical field is a standard surgical practice. Physicians shall not report a HCPCS/CPT code describing exploration of a surgical field with another HCPCS/CPT code describing a procedure in that surgical field. For example, CPT code 22830 describes exploration of a spinal fusion. CPT code 22830 shall not be reported with another procedure of the spine in the same anatomic area. However, if the spinal fusion exploration is performed in a different anatomic area than another spinal procedure, CPT code 22830 may be reported separately with modifier 59."
What is considered to be a "different anatomical area"? I'm assuming that If the physician does an exploration and hardware removal at L1-L2, and then does a laminectomy (63047) at L2-L3 via the same incision, both the exploration and hardware removal are bundled into the laminectomy? And that a different spinal level is NOT a "different anatomical area"?
Is it only separately billable if it is performed with a separate incision, into a different spinal area, such as cervical or thoracic?
Is there any documentation that specifically addresses this?
Thank you for your consideration!
