Nicole Posted Thu 07th of March, 2019 14:29:16 PM
Procedures Performed: Patient had C5 Corpectomy. C4-C6 Anterior Fusion, Titanium Cage, Screws, Plate, Morcelized Allograft. Procedure Description: Discectomy was performed at C4-5 and C5-6. Then bilateral decompression and foraminotomies were completed. The C5 vertebral body was removed en bloc. Titanium cage was packed with morcelized allograft/autograft and packed into the interspace. Screws were used to bridge the endplates from C4 - C6. Would the CPT codes be as follows: 63081 (C5), 22554 (C4-5), 22585 (C5-6), 22854 (Titanium Cage), 22845 (Instrumentation), 20930 (Morcelized Allograft), 77003 (Fluoroscopy)
SuperCoder Answered Fri 08th of March, 2019 09:23:13 AM
Thanks for your question.
As per the limited documentation provided, the codes looks appropriate except 22554 and 22585. Since, the decompression is also performed please check code 22551 and 22552 and also add modifier 59 due to CCI edits.
Hope this helps.
Nicole Posted Fri 08th of March, 2019 15:39:39 PM
I do not believe your response is the correct answer in regards to the question I am asking. I thought you could not bill for discectomy above and below the level of the corpectomy because it is included in the code 63081. Therefore you would not be able to bill the 22551/22552. Can you please re-look at your response and verify. I am not sure what is justifying the use of the 22551/22552 per your response.
SuperCoder Answered Mon 11th of March, 2019 09:31:32 AM
This is one of the scenarios where coding can be done in two ways. Either way there would be loss of reimbursement due to bundling issue.
Either we can bill for corpectomy performed at C5 level. CPT code 63081 which has a value of $ 1843.40 will be billed. In this case we will not bill for discectomy, foraminotomy and decompression performed at at C4-C5 and C5-C6 level. If we code CPT code for discectomy, foraminotomy and decompression at C4-C5 and C5-C6 level, codes 22551 and 22552 whose combine value is $2209.20 will be billed only. We will not be coding for corpectomy.
We did further research and came across this article. This is more of a similar kind of scenario which can be helpful. Please click on the link below to access the article. If you are unable to access please do let us know so that we can provide you the complete article.
Hope this helps.
Nicole Posted Tue 12th of March, 2019 08:22:46 AM
Thank you very much!
SuperCoder Answered Wed 13th of March, 2019 01:28:21 AM
Thank you, happy to help.