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Susan Posted 6 Year(s) ago

What CPT codes should be used for posteior lumbar interbody fusion
L4-5,L5-S1 and a complete revision endoscopic microdiscectomy via transforaminal approach L4-5,L5-S1.

SuperCoder Posted 6 Year(s) ago

The Proper CPT code should be...
22630 and 22632

Susan Posted 6 Year(s) ago

The doctor wants to use 22630 22632 22612 22614. Can you please tell me under what circumstances these codes would be used together.

SuperCoder Posted 6 Year(s) ago

Example:
If 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 fusion and 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.
Reference Links:-
http://www2.aaos.org/aaos/archives/bulletin/aug04/code.htm
http://www.supercoder.com/articles/articles-alerts/nec/reader-questions-2-fusions-at-1-level-1-code-only/?zoom_highlight=22630+and+22612
http://www.supercoder.com/articles/articles-alerts/nec/reader-questions-dont-lose-out-on-additional-plif-reimbursement/?zoom_highlight=22630+and+22612
http://www.supercoder.com/articles/articles-alerts/orc/ncci-update-revisit-any-2263022612-claims-you-submitted-in-the-last-6-months/
http://www.supercoder.com/articles/articles-alerts/nec/dont-forget-to-code-for-all-aspects-of-plif-to-achieve-optimal-reimbursement/

SuperCoder Posted 6 Year(s) ago

The codes used to report arthrodesis, 22548-22632 are classified by the anatomical approach used and the technique employed to accomplish the fusion. CPT codes 22630 and 22632 describe arthrodesis performed by posterior interbody technique, which is a fusion of the lumbar vertebrae, primarily accomplished by placement of a bone graft in the space between two vertebral bodies (interspace), using a posterior approach.

However CPT 22612-22614 describe the posterolateral/posterior approach (not interbody fusion).Hence, this is not appropriate to code 22630 and 22612 both(as per given scenario).

here to note that these code may be billed together if applicable as per operative procedure. I may assist you in a better manner if you could provide me the more detail about the actual procedure.

Susan Posted 6 Year(s) ago

Is there a way I can fax the operative report to you for your review?

SuperCoder Posted 6 Year(s) ago

You can copy(from word file) your operative notes and paste is this box. If you are unable to include your text here, you may send the OP report to my e-mail ID (srana@codinginstitute.com).

Thanks:
Snay

Susan Posted 6 Year(s) ago

I am sending the operative report to your email in a few minutes. Thank you so much Sany for all your help. I look forward to seeing your response.
sue

SuperCoder Posted 6 Year(s) ago

Hello Sue,

Thanks for sending the OP report. Please allow me some time (1 working day) to review and reply.

SuperCoder Posted 6 Year(s) ago

Hello Sue,

Here is the solution.

22630 – L4-L5 Fusion
22632 - L5-S1 Fusion
22851 – Spinal prosthesis (cage and Stimulator)
20930 – Autograft (iliec graft – separate incision)
20937 – Allograft (bone chip)
0232T – Plasma Rich platelet injection

* Fluroscopy, discogram, discectomy are inclusive to 22630.

**Greater trochanteric bursitis injection and insertion of PCEA catheter performed by Dr. Ragukonis (having separate op report), so it will not be coded here.

Posted by Susan, 6 Year(s). There are 10 posts. The latest reply is from SuperCoder.

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