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OP report-help

Arul karthik Answered Thu 20th of October, 2011 17:27:44 PM

Please help with the next OP report

Patients dx are thoracolumbar scoliosis, L1-S1 stenosis, L1-S1 degenerative disk disease

L1-Si laminectomies and bilateral facetectomies 63047,63048x4
L2-L5 posterior diskectomies
L2-L5 posterior interbody arthrodesis 22630,22632x2
Intervertebral device at L2-L3,L3-L4,L4-L5 22851x3
T10-S1 posterior segmental instrumentation 22843
T10-S1 posterior and posterolateral arthrodesis 22612,22614x7

Are this codes correct or should I use 22802 for arthrodesis? Does 22802 includes posterior and interbody arthrodesis?

Thank you so much.

SuperCoder Answered Fri 21st of October, 2011 07:24:04 AM

Hi

L1-S1 – 63047, 63048 (dx – stenosis)
L2-L5 - 22630, 22632X2, 22851 X3 (degenerative disk disease)

T10 – S1 - 22802 (dx – scoliosis)
As per scenario it seems that arthrodesis with instrumentation for T10-S1 is performed for Scoliosis (a kind of spinal deformity), so the code should be 22802 and 22843 (not 22612, 22614).

22802 include posterior arthrodesis but not interbody fusion, so interbody fusion will be coded separately.

Thanks

Arul karthik Answered Fri 21st of October, 2011 15:15:39 PM

Thank you. I was doubting 22802 and 22612 with so many units. May I ask why did you use 63048 only with one unit when the lami and facetectomy was done from L1 to S1, six vertebras or 5 interspaces?

thank you.

SuperCoder Answered Mon 24th of October, 2011 08:16:13 AM

You are right!!! It should be 63047, 63048X4.

It is my mistake that I missed the unit for 63048.

I apologized for the confusion.

SuperCoder Answered Thu 01st of December, 2011 14:48:29 PM

Please help with op rpt and what is payable or bundled procedures.
Preparation of space L4-S1 for fusion 22630
Insertion of cages 22851 x 2
Use of allograft 20930
Decompressive lumbar laminectomy, facetotomy, and foraminotomy and disc excision L4-S1 63047,63048
Repair of Dural tear 63709
Im not sure if Arthrodesis 22630 bundles with 63047
Thanks so much.

SuperCoder Answered Thu 01st of December, 2011 17:02:18 PM

22630 includes 63047. If you are coding these for different vertebral segments, then modifier 59 with 63047 is allowable to be coded with 22630

Arul karthik Answered Fri 02nd of December, 2011 22:15:51 PM

Last year’s AANS seminar had this to say about it:

• CPT considers it an accurate coding combination, if decompression above that needed for the PLIF is performed and documented.
• In 2000, CPT added “including laminectomy and/or discectomy to prepare interspace (other than for decompression)” to 22630 (PLIF code).
• CPT Assistant, January 2001 says (paraphrased) “the appropriate 63045-63048 codes (s) should be reported when in addition to removing the disc and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root (s) which requires work in excess of that normally performed when doing a posterior lumbar interbody fusion (PLIF). For example, in spinal procedures performed on patients having lateral lumbar stenosis, the surgeon may need to peform additional work above and beyond that described by the PLIF, including facetectomy (ies) and/or foraminotomy (ies) to adequately decompress the nerve roots. For the purpose of this example code 63047 should be reported in addition to code 22630.

CPT 22630 doesn’t capture everything and it states in CPT “other than for decompression”. So if the surgeon needs to decompress the nerve you should be able to bill for it using 63047.

SuperCoder Answered Sun 04th of December, 2011 07:14:40 AM

As per CPT Asst. 2001 Jan, your statement is correct that code 63047 should be reported in addition to code 22630. But as per latest NCCI version 17.3, 63047 bundles with 22630. Therefore, you have to code 63047 as a separate laminectomy and decompression with code 22630 (posterior technique which includes laminectomy and without decompression) and you have to append -59 modifier to 63047 to overcome the bundling edits. So final codes should be:
22630
63047-59
63709-59
22851x2
20930

For your reference:

2006: http://www.supercoder.com/articles/articles-alerts/pbi/neurosurgery-coder-wins-back-300000-for-neurosurgery-practice/

2007: http://www.supercoder.com/articles/articles-alerts/nec/modifier-59-made-easy-look-for-a-separate-locationsession/?zoom_highlight=correct+coding+initiative+edits+bundled+63047+into+22630

2008: http://www.supercoder.com/articles/articles-alerts/nec/reader-questions-snag-separate-plif-and-laminectomy-pay-11277/?zoom_highlight=correct+coding+initiative+edits+bundled+63047+into+22630

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