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Cervical fusion

Caralee Posted Wed 03rd of April, 2013 11:15:12 AM

Need coding help with cervical fusion. Provider performed C3-T1 Laminectomy for decompression of stenosis and C3 to T2 Posterior cervical fusion. I have 63045, 63046 and 63048x4 for laminectomy and 22600, 22610 and 22614X5 for fusion. Would it be correct coing to use 63046-Thoracic laminectomy and 22610 for thoracic fusion or add segments to 63048 and 22614? Thanks

SuperCoder Answered Wed 03rd of April, 2013 14:52:44 PM

You are correct in coding. Laminectomy for stenosis and arthrodesis are to be coded separately. Please seethe CPT guidelines in "Arthrodesis" section, just above the code 22532 which says:

"Arthrodesis may be performed in the absence of other procedures and therefore when it is combined with another definitive procedure (eg, osteotomy, fracture care, vertebral corpectomy or laminectomy), modifier 51 is appropriate."

You can bill 63046 and 22610 together. And also can add add-on code as per no. of segments. These codes are based on "each segment of vertebra" and therefore the calculation is correct.

Caralee Posted Thu 04th of April, 2013 23:18:18 PM

Is it consider in this case double billing to use 63046 with 63045 for laminectomy and 22610 with 22600 for fusion OR use only 22600 with 22614 X6 for fusion and 63045 with 63048 X 5 for laminectomy? Thanks.

SuperCoder Answered Fri 05th of April, 2013 10:20:50 AM

It's not double billing. If you code only 22600, 22610, 22614 (multiple units), and drop 63K series, then you are losing reimbursement for the "Laminectomy" portion. Codes 22600-22614 are for fusion only, Laminectomy is not included in them.

Similarly, codes 63045, 63046, 63048 (multiple units) are for Laminectomy, but fusion is not inclusive of them. So need to code them separately.

And, 22614 and 63048 are add-on codes and as per "each vertebral segment". So you need to calculate and use multiple units with them. And both 22600 and 22610 are required since one is for "cervical vertebra" and the other is for "thoracic vertebra". Same happens in case of 63045 and 63046 too.

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