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Guidelines aid coding of hardware removal, hemi-laminectomy

In this edition of Spine Surgery Today, Teri Romano, RN, MBA, CPC, and Kim Pollock, RN, MBA, CPC, provide readers with more coding tips to answer the billing challenges in spine practices.

– Daniel Refai, MD

Associate Editor, Neurosurgery

Daniel Refai

Daniel Refai

This article is the second in a series to focus on common coding conundrums encountered by spine surgeons. Accurate coding can be challenging and frustrating because codes change, as do coding and reimbursement guidelines.

We discuss in this article just a few of the coding questions we are commonly asked. Watch for more answers to common spine surgery coding and reimbursement questions in future Spine Coding Source columns.

Question: I performed a one-level hemi-laminectomy with a facetectomy and foraminotomy on a patient with lumbar stenosis. Based on CPT code descriptors, should this be billed as 63030 since it was a hemi-laminectomy?

Teri Romano, RN, MBA, CPC, and Kim Pollock, RN, MBA, CPC: The CPT codes for laminectomies and hemi-laminectomies are intended to be reported by the diagnosis or pathology being treated. For example, if the patient’s primary pathology is lumbar stenosis and a hemi- or complete laminectomy with a facetectomy and foraminotomy is performed, 63047 is reported as the primary code for the first level. If the pathology and definitive treatment is for lumbar disc disease, 63030 is reported for the first level treated (CPT Assistant, December 2012).

Teri Romano

Teri Romano

Kim Pollock

Kim Pollock

Question: I routinely use fluoroscopy to aid placement of rods and screws in posterior spine surgery. I bill 76000 and usually get paid, but a colleague told me this was incorrect coding. Is she right?

Romano and Pollock: She is correct. Fluoroscopy is included in the surgical global period for all open spine procedures and should not be separately billed. Payers may mistakenly reimburse 76000, but it is incorrect coding and an audit in the future could request a payback for overpayment. Remember, just because you were reimbursed for a code does not mean it was accurately reported.

Question: I removed damaged rods and screw from L3-5 and placed new hardware at L3-5. Do I bill a removal code of 22852 and 22842, or just 22842?

Romano and Pollock: You should bill neither code. Since you removed and replaced instrumentation at the same levels (L3-5) you will need to report 22849, reinsertion of spinal fixation device. This code specifically includes the removal and reinsertion of instrumentation at the exact same level.

Question: In a recent patient, I removed instrumentation from L3-5 and added new instrumented fusion above at L2-3. Since the L3 screws use the old holes, but the L2 screws are new, how would the hardware removal and insertion of adjacent level hardware be coded?

Romano and Pollock: CPT states “Only the appropriate insertion code (22840-22848) should be reported when previously placed spinal instrumentation is being removed or revised during the same session where new instrumentation is inserted at levels including all or part of the previously placed instrumented segments.” So in this scenario, only the new instrumentation, 22840, would be reported. If, however, you placed new screws at L2 but a new rod from L2-5, then you would report 22842.  

Question: My coder tells me I am required to document the amount of bone removed before a corpectomy can be billed. Is there an official reference that supports this, and how much bone has to be removed?

Romano and Pollock: In the April 2012 issue of CPT Assistant, an official publication of the American Medical Association, it was explained that a corpectomy at the cervical level requires removal of at least 50% of the bone. At the thoracic and lumbar level, the amount of bone removal required is one-third, or approximately 33% of the bone.

Question: What code is used to report incision and drainage of a postoperative wound infection in the lumbar spine? The only code I can find is 10180, but I went below the fascia and this code does not seem to describe what I did.

Romano and Pollock: There is a more specific CPT code for that situation. Code 22015 incision and drainage, open, of deep abscess (subfascial) posterior spine; lumbar, sacral or lumbosacral. Code 22010 is the parallel code for a cervical infection. These codes have a 90-day global period and also include instrumentation removal to access the infection. Do not forget to append modifier 78 (unplanned procedure for a related procedure in the global period) to your code.

If you have a coding conundrum, please submit your questions to spine@healio.com for possible inclusion in a future column in Spine Coding Source on frequently asked questions in spine coding.

Disclosures: Pollock and Romano report no relevant financial disclosures.

In this edition of Spine Surgery Today, Teri Romano, RN, MBA, CPC, and Kim Pollock, RN, MBA, CPC, provide readers with more coding tips to answer the billing challenges in spine practices.

– Daniel Refai, MD

Associate Editor, Neurosurgery

Daniel Refai

Daniel Refai

This article is the second in a series to focus on common coding conundrums encountered by spine surgeons. Accurate coding can be challenging and frustrating because codes change, as do coding and reimbursement guidelines.

We discuss in this article just a few of the coding questions we are commonly asked. Watch for more answers to common spine surgery coding and reimbursement questions in future Spine Coding Source columns.

Question: I performed a one-level hemi-laminectomy with a facetectomy and foraminotomy on a patient with lumbar stenosis. Based on CPT code descriptors, should this be billed as 63030 since it was a hemi-laminectomy?

Teri Romano, RN, MBA, CPC, and Kim Pollock, RN, MBA, CPC: The CPT codes for laminectomies and hemi-laminectomies are intended to be reported by the diagnosis or pathology being treated. For example, if the patient’s primary pathology is lumbar stenosis and a hemi- or complete laminectomy with a facetectomy and foraminotomy is performed, 63047 is reported as the primary code for the first level. If the pathology and definitive treatment is for lumbar disc disease, 63030 is reported for the first level treated (CPT Assistant, December 2012).

Teri Romano

Teri Romano

Kim Pollock

Kim Pollock

Question: I routinely use fluoroscopy to aid placement of rods and screws in posterior spine surgery. I bill 76000 and usually get paid, but a colleague told me this was incorrect coding. Is she right?

Romano and Pollock: She is correct. Fluoroscopy is included in the surgical global period for all open spine procedures and should not be separately billed. Payers may mistakenly reimburse 76000, but it is incorrect coding and an audit in the future could request a payback for overpayment. Remember, just because you were reimbursed for a code does not mean it was accurately reported.

Question: I removed damaged rods and screw from L3-5 and placed new hardware at L3-5. Do I bill a removal code of 22852 and 22842, or just 22842?

Romano and Pollock: You should bill neither code. Since you removed and replaced instrumentation at the same levels (L3-5) you will need to report 22849, reinsertion of spinal fixation device. This code specifically includes the removal and reinsertion of instrumentation at the exact same level.

Question: In a recent patient, I removed instrumentation from L3-5 and added new instrumented fusion above at L2-3. Since the L3 screws use the old holes, but the L2 screws are new, how would the hardware removal and insertion of adjacent level hardware be coded?

Romano and Pollock: CPT states “Only the appropriate insertion code (22840-22848) should be reported when previously placed spinal instrumentation is being removed or revised during the same session where new instrumentation is inserted at levels including all or part of the previously placed instrumented segments.” So in this scenario, only the new instrumentation, 22840, would be reported. If, however, you placed new screws at L2 but a new rod from L2-5, then you would report 22842.  

Question: My coder tells me I am required to document the amount of bone removed before a corpectomy can be billed. Is there an official reference that supports this, and how much bone has to be removed?

Romano and Pollock: In the April 2012 issue of CPT Assistant, an official publication of the American Medical Association, it was explained that a corpectomy at the cervical level requires removal of at least 50% of the bone. At the thoracic and lumbar level, the amount of bone removal required is one-third, or approximately 33% of the bone.

Question: What code is used to report incision and drainage of a postoperative wound infection in the lumbar spine? The only code I can find is 10180, but I went below the fascia and this code does not seem to describe what I did.

Romano and Pollock: There is a more specific CPT code for that situation. Code 22015 incision and drainage, open, of deep abscess (subfascial) posterior spine; lumbar, sacral or lumbosacral. Code 22010 is the parallel code for a cervical infection. These codes have a 90-day global period and also include instrumentation removal to access the infection. Do not forget to append modifier 78 (unplanned procedure for a related procedure in the global period) to your code.

If you have a coding conundrum, please submit your questions to spine@healio.com for possible inclusion in a future column in Spine Coding Source on frequently asked questions in spine coding.

Disclosures: Pollock and Romano report no relevant financial disclosures.