Jacob Posted Wed 01st of January, 2020 09:30:54 AM
If I perform L5-S1 ALIF in supine position, the flip to later position and continue with L2-L5 XLIF, can I code both CPT codes 22558 and 22533?
SuperCoder Answered Thu 02nd of January, 2020 04:20:00 AM
CPT code for procedures ALIF and XLIF is same i.e. 22558 and +22585 for multiple levels.
ALIF Signals Anterior Approach
If the operative note specifies ALIF, your surgeon completed anterior lumbar interbody fusion. The procedure is similar to PLIF and TLIF, but the surgeon uses an anterior approach, usually through an incision in the lower abdominal area or the patient's side. Whether the surgeon chooses an anterior or posterior approach usually is at his discretion and based on his or her preference.
Because of the anterior approach, you submit 22558 (Arthrodesis, anterior body technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar). Include +22585 (... each additional interspace [List separately in addition to code for primary procedure]) for multiple levels.
New Technique Could Be XLIF
One of the newest spinal fusion techniques is extreme lateral interbody fusion, or XLIF. "The surgeon accesses the disc from a small incision on the patient's side. He sometimes makes another small incision just behind the first.
Because the XLIF approach is minimally invasive, the surgeon uses fluoroscopy to provide real-time images of the spine. He removes the disc material and replaces it with a bone graft and cage.
Code it: Report XLIF with 22558 and +22585. Pay attention to your physician's documentation and the additional levels you code, because the surgeon usually can access only one or two levels at a time.
22533 will be incorrect code for XLIF procedure. CPT 22533 is used when surgeon performs a lateral extracavitary arthrodesis with minimal discectomy.
Please also check below links for better understanding:
Hope this helps!