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Arul karthik Answered Fri 30th of September, 2011 16:17:23 PM

posterior or posterolateral arthrodesis should be billed by vertebra or interspace 22600-22614?

thank you

SuperCoder Answered Fri 30th of September, 2011 17:46:21 PM

Arthrodesis is a procedure to remove the cartilage of any joint to encourage bones of that joint to fuse, or grow together, where motion is not desired.
Confusion in selecting arthrodesis codes results from the use of CPT terms ‘interspace’ and ‘vertebral segment.’ Both terms are used in the arthrodesis section. However, code 22612 describes “Arthrodesis, posterior or posterolateral technique, single level; lumbar” and code 22614 states for “each additional vertebral segment.” This seems to be giving conflicting information as to how to appropriately code for multiple level arthrodesis. Fusing a single level technically includes two vertebrae and the intercalary disc. A single vertebra cannot be fused to itself, and adding another vertebra to the fusion requires the crossing of an interspace.

So, coding for arthrodesis for example of T9-L2, posterior approach, would specify 22612 for fusing L1-L2, and 22614x4 for fusing T9-T10, T10-T11, T11-T12, and T12-L1.

Arul karthik Answered Fri 30th of September, 2011 18:06:02 PM

In example you have given why didn't you use 22612, 22610 and 22614*3? And also when you have posterior/posterolateral and interbody arthrodesis do you bill 22630-22632 along with 22612-22614?

Thank you.

SuperCoder Answered Fri 30th of September, 2011 20:40:11 PM

You can understand with any one example. For example, when there is no mention of lumbar region, but only of thoracic interspaces, then you can use 22610 in place of 22612, and for additional vertebral segment 22614.

The concern regarding billing 22630 and 22612 together for the same surgical session usually begins because the coder wonders if there is a separate posterolateral fusion at the spinal level in question. For example, a neurosurgeon performs a PLIF and diskectomy using iliac crest graft for fusion at L5-S1. The neurosurgeon is doing an L5 discectomy with posterior interbody fusionand pedicle screws with posterolateral fusion of the facet joint of L4-L5. The posterior interbody fusion is considered separate from the posterolateral fusion because it is done at a different part of the vertebral interspace. Further, 22612 does not include the minimal discectomy that 22630 does, which is why it is appropriate to code 22612 together with 22630

If a structural posterolateral fusion is performed, he will bill 22630 and 22612 with a modifier 51 together and has seen them paid when billed as components because there are no Correct Coding Initiative (CCI) bundles for them.

Arul karthik Answered Fri 30th of September, 2011 21:12:31 PM

To understand corectly you can bill 22612 and 22630 if done for PLIF at L5-S1?

My question was regarding your example of arthrodesis from T9-L2 which includes lumbar and thoracic vertebras, should 22610-thoracic, 22612-lumbar and 22614x3 for the remaining vertebras be used? And if only 22612 and 22614x4 should be used why did you chose the lumbar code and not the thoracic code to be the primary?

Thank you.

SuperCoder Answered Mon 03rd of October, 2011 06:55:15 AM

Well, I have not mentioned that way, but to give better clarification, I request you to refer to following links:-

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