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TLIF / Posterior Segmental Instrumentation Fusion

Nicole Posted Mon 27th of August, 2018 16:30:42 PM
If a provider does a TLIF from L2-3 and L4-5 (22633, 22634) and also does a L2-L5 posterior segmental instrumentation and fusion (22612,22614) along with left sided laminectomy at the L3-4 (63047). Can the laminectomy (63047) or posterior instrumentation/fusion (22612) be billed for the level at the L3-4? Or does the TLIF include those segments since the procedure code states interspace and segment?
SuperCoder Answered Tue 28th of August, 2018 06:15:32 AM

Hi Nicole, 

In the above scenario, CPT code 63047 is billable for L3- L4 (considering it to be the work done on the separate interspace).Please append odifier 59 to CPT code 22633. Also, according to NCCI edits, appeal for CPT 22612 with modifier XS (Separate structure) for reimbursement for the procedure performed on a separate structure. 

Hope this helps!

Good day.


Nicole Posted Tue 28th of August, 2018 08:32:24 AM
So for the L3-L4, the Laminectomy and Posterior segmental instrumentation/fusion can be billed? Would that be (L3)63047/22612 and (L4)63048/22614 since the procedure codes are per segment? Also, I am confused in regards to the above mention of appealing of 22612 with the XS modifier, is the spine not considered one structure?
SuperCoder Answered Wed 29th of August, 2018 03:34:21 AM

Hi Nicole,

According to the above given information, TILF is performed on L2-3 and L4-5 and posterior segmental instrumentation and fusion is done on L2-5.

CPT Code 22633 describes a posterior lumbar arthrodesis performed both in the disc space as well as on other bony surfaces of the posterior spine.  This procedure also includes laminectomy and discectomy. It is correct report 22633 when the surgeon does both a posterior interbody arthrodesis and a posterolateral arthrodesis.

Also, CPT Code 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) and 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace [other than for decompression], single interspace and segment; lumbar) are both codes for posterior lumbar arthrodesis, but the specific location of the fusion performed is different. 

In the given scenario, posterolateral fusion reported with code 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with lateral transverse technique, when performed]) is performed on a separate level (L3-4). 

However, performing both posterior or posterolateral fusion and posterior interbody fusion at the same vertebral level in the lumbar region should be reported by one combined code.

In other words, under no circumstance does CMS allow you to bill 22633 with 63047 as long as they share the same interspace. Essentially, Medicare is saying that the work of a laminectomy overlaps enough with an arthrodesis of the same interspace that the laminectomy is to be considered an inclusive part of the fusion.

Scenario 2, however, according to the above documentation, bill out both 22612 and 63047 since the laminectomy occurs at a separate spinal interspace. You will apply modifier 59 (Distinct procedural service) or modifier XS (Separate structure) to 63047. In order to increase the likelihood of full reimbursement, consider sending these procedures as a paper claim with a written justification for the use of modifier 59 attached. Any combination of 22630/22633 with 63042/63047 is not billable if the physician performs both procedures at the same interspace while CPT code 22612 and 63047 is billable with appropriate modifiers.

Hope this helps!

Further query is welcome.

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