Wiki Bilateral facetectomies - Annulotomies and diskectomies

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stephross97

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I am attaching a chart note and I am hoping someone can help me. I haven't done spinal coding before so any help is appreciated.

PROCEDURES
1. Bilateral facetectomies at the L3-L4, L4-5, L5-S1 levels complete decompression of all neural elements.

2. Placement of bilateral pedicle screws using the Medtronic Solera implant system with 6.5 x 50 mm screws being placed at L3, a 6.5 x 50mm screws system with 6.5 x 50 mm screws being placed at L3, 6.5 x 50 mm screws being place at L5, a 6.5 x 50 mm on the patient's left at S1, and a 6.5 x 45 mm screw on the patient's right at S1. All screws were placed using image guidance navigation.

3. Annulotomies and diskectomies bilaterally with placement of two 10 x 22 mm grafts at L5-S1 in PLIF fashion, two 10 x 26 mm grafts at L4-5 in PLIF fashion, and two 10 x 26 mm grafts at L3-4 in PLIF fashion. Interbody grafts were Medtronic capstone interbody grafts filled with DBM. All grafts were places also under image guidance.

4. Decortication of lateral processes with placement of a mixture of autograft, allograft, and DBM for posterolateral fusion. A 110 mm rod was placed on the left and a 100 mm rod was placed on the right, and they were locked down with locking end caps. A Crosslink was placed in between the L3-4 interspace. Again, all implants and screws were placed under image guidance.

Thank you in advance for any and all help.
 
I do these cases everyday and this is what I would bill for this case.

22633-PLIF/PLF Combo L3-4
22632x2-PLIF L4-5, L5-S1
63047-59-Decompression L3-4
63048x2-Decompression L4-5, L5-S1
22842-Segmental Instrumentation L L3, L5, and S1
20930-allograft
20936-autograft

The annulotomies and diskectomies cant be separately billed as they are included and incidental.

NOTE: If this is Medicare, 63047/63048x2 wont be paid. Per AANS, you should bill with modifier 51 instead of 59. They are appealing the CMS decision. If they every overturn it, those codes would have to be on the original claim and that was the suggestion from AANS.
 
clarification on grafts you coded

Sara,

On the grafts that were coded, 20936 and 20930, do you add any modifiers? Medicare is not paying the graft codes on our surgeries for PLIF. SUGGESTIONS???? They are add-on codes so any help would be appreciated??

Dee
 
Unfortunately because they are add on codes, modifiers wouldn't apply. I know in Florida, First Coast did not set a fee amount for 20930/20936, so we are having to adjust them off. I still report them for proper billing, especially with the onlay fusions my providers do, but still aren't getting reimbursed from Medicare. Some of the commercial carriers pay it but that's hit of miss. For some reason, most dont see the need to pay although Im not sure how they expect our providers to fuse without a graft.
 
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