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Yvette Posted Tue 14th of May, 2019 16:56:40 PM
Patient has L1-S1 stenosis with a lateral listhesis and DJD and Scoliosis. Operation performed 1. Segmental instrumentation L1, L2, L3, L4, L5, AND S1 with bilateral pedicle screws. 2. Posterolateral fusion with interbody fusion at L2-L3 AND L3-L4. Posterolateral fusion w/o interbody at L4-L5, L5-S1 AND L1-L2. 3. Laminectomy as part of transforaminal lumbar interbody fusion at L2-L3 AND L3-L4. 4. Use of stereotactic navigation for spine surgery. 5. Use of Peek interbody cage L2-L3 and L3-L4. 6. Use of local autograft for spine surgery through same incision. 7. Use of allograft for spine surgery. Would the following codes be correct? CPT 22633, 22634, 22614X3, 22842, 22853X2, 61783, 63047, 63048, 20930, 20936.
SuperCoder Answered Wed 15th of May, 2019 09:04:52 AM


Thanks for your question.

As per the limited document and procedure names the codes given are appropriate to use except for code 63047 and 63048.

According to chapters 4 and/or 8 of the 2017 NCCI Policy Manual:

CMS payment policy does not allow separate payment for CPT® codes 63042 (laminotomy...; lumbar) or 63047 (laminectomy...; lumbar) with CPT® codes 22630 or 22633 (arthrodesis; lumbar) when performed at the same interspace. If the two procedures are performed at different interspaces, the two codes of an edit pair may be reported with modifier 59 appended to CPT® code 63042 or 63047.”

You can also go with the below mentioned link for the article.

Hope this helps.


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