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Jessica Posted 5 Year(s) ago

I coded 63016, 22327,22610,22843,22614-59x5. However I am not sure it is correct as the operative report notes decompression at T7- this was area the cord was completely decompressed in this region. High speed drill was used to create openings for the laminar hooks at T4 T5 T8 T9 T10. Titanium rods & screws were implanted.

SuperCoder Posted 5 Year(s) ago

I need a broader description to get into a more clear picture. Based on the description your codes seems correct. We do have a coding scenario of this type in our alert. I believe this matches your scenario.

Coding Case Study

"The physician did a posterior spinal fusion with instrumentation from L3 to T7 " says Eileen Bradley CPC coding specialist at Brigham and Women's Hospital in Brookline Mass. Between counting the numerous levels involved and the added twist of the fusion traversing more than one region of the spine the procedure presents several coding challenges. In this case the biggest risk is undercod-ing which means lost revenue for the practice.

The surgery presents two potentially "correct" coding sequences. The procedures performed are clearly delineated but the uncertainty lies with how often to record them on the claim form and in what order.

The five procedures performed were the following:

20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision)
22610 Arthrodesis posterior or posterolateral technique single level; thoracic (with or without lateral transverse technique)
22612 ... lumbar (with or without lateral transverse technique)
22614 ... each additional vertebral segment (list separately in addition to code for primary procedure)
22843 Posterior segmental instrumentation (e.g. pedicle fixation dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments.

The coding debate begins when choosing how to report the procedures. Conventional coding wisdom says to pick the code with the highest relative value units (RVUs) and put it first on the list followed by secondary codes with modifiers if applicable. Heidi Stout CPC CCS-P coding and reimbursement manager for University Orthopaedic Associates in New Brunswick N.J. maintains "Since 22614 is the add-on code for any additional level meaning it does not specify cervical thoracic or lumbar all other fusions after the first level are reported with 22614." Using that approach the coder reports the code with the highest RVU first and continues as follows:
22612 (L2-L3)
22614 x 7 (for the additional segments including T7-T8 T8-T9 T9-T10 T10-T11 T11-T12 T12-L1 L1-L2).
But in Bradley's case the thoracic and lumbar fusions could be considered "primary." Some coders advocate listing both primary codes on the claim form and modifying one with modifier -51. In other words the fusions are always broken into distinguishable primary surgery codes e.g. the initial thoracic fusion plus added levels and the initial lumbar fusion plus added levels. Using that rationale the claim form would read as follows:

22612 (L2-L3)
22610-51 (T7-T8)
22614 x 6 (for the additional segments including T8-T9 T9-T10 T10-T11 T11-T12 T12-L1 L1-L2)
The North American Spine Society publishes Common Coding Scenarios for Spine Procedures and Injection Techniques a guide that breaks down coding for the most common spine procedures and appears to resolve this debate. Based on its example when a fusion or other procedure crosses from one spinal area into another (e.g. thoracic to lumbar) coders should still pick only one code for the primary then use 22614 for all additional levels regardless of whether they are thoracic lumbar or cervical.

Jessica Posted 5 Year(s) ago

63016, 22327-59,22610-59,22843,22614-59x5. Incision made along both sides of laminar margin. Spinous process were uncovered & fractures of the right lamina out to the lateral masses of T6 & T7 were identified, as well as T8, & the spinous process fractures of 4&5 also appreciated. Lamina 4 & 5 were completely intact & able to assist sustaining compression from laminar hooks. Once decompressed at T7, the dura was completely decompressed & any signs of any hematoma or epidural fat was removed exposing the canal dura & the cord which was completely decompressed in this region. High speed drill was used to create openings for the laminar hooks at T4 T5 T8 T9 T10. These were then placed in all these positions & Titanium rods & screws were implanted.The area was realigned under fluoro guidance; areas were locked down & decortication then occurred. The bone had been removed from the spinous processes of 4 5 6 7. lamina 7 8 9 10 were morselized, autograft was placed in & around using BMP as well, implanted in & around all the areas for added bone growth. Retractors removed, wound closed.

Posted by Jessica, 5 Year(s). There are 3 posts. The latest reply is from Jessica.

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