Replacement Code for Interbody Cage for Disc

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1 vs October 22, 2015 We ve been told we cannot bill and with the ACDF code, Is this true? It is true if you are thinking about reporting (intervertebral device) and (structural allograft) at the same spinal level. For example, you would not use a PEEK device (+22851) and a structural allograft (+20931) in the same interspace such as at C5-C6. Rather, you would use one or the other. However, if different products are used at different levels, then it is acceptable to report both codes. For example, a PEEK device is placed at C5-C6 while a structural allograft is placed at C6-C7. *This response is based on the best information available as of 10/22/15. Replacement Code for Interbody Cage for Disc January 5, 2017 I see that CPT code Application of intervertebral biomechanical device(s) to vertebral defect or interspace was

2 deleted in What code do I use in 2017 for placement of an interbody cage for disc that does not have integral fixation and is being used for fusion? I see the new codes and both say with integral anterior instrumentation device for anchoring. Three codes have been added to CPT 2017: is used for interbody device insertion, with fusion, with or without integrated anterior fixation is used for interbody device insertion for corpectomy, with fusion, with or without integrated anterior fixation is used for interbody device insertion without fusion Your options will be or 22854, depending on whether performing corpectomy and both say with integral anterior instrumentation for device anchoring when performed. If you do not use integrated fixation, it is still the same codes. If you use a separate plate, that would be reportable when specific criteria are met (e.g. the plate crosses the interspace, can provide independent stabilization, and can be used with any other type of interspace device.) To learn everything you need to know about the NEW 2017 CPT codes for spine surgery click here. *This response is based on the best information available as of 01/05/17.

3 New Spinal Cage Codes 2017 January 5, 2017 I see that CPT code , Application of intervertebral biomechanical device(s) to vertebral defect or interspace was deleted effective 1/1/17. What code do I now use? Three codes have been added to CPT 2017 to replace : is used for a device, with fusion, with or without integrated anterior fixation is used for a device to fill a corpectomy defect, with fusion, with or without integrated anterior fixation is used for interbody device insertion without fusion Note that and include the integral anterior instrumentation for device anchoring when that type of device is used. If you do not use integrated fixation, it is still the same codes, or If you use a separate plate, you may separately report a code such as when the plate meets the code criteria (e.g., the plate crosses the interspace, can provide independent stabilization, and can be used with any other type of interspace device). To learn everything you need to know about the NEW 2017 CPT codes for spine surgery click here. *This response is based on the best information available as of 01/05/17.

4 KZA Webinar 2017 Coding Update for Spine Surgery Who should attend? Orthopaedic surgeons Neurosurgeons Practice managers Billing managers Coders Billing staff What s discussed: What s new for spine diagnosis coding (ICD-10-CM). What s new for spine procedural coding (CPT) including: Deletion of (intervertebral device) and replacement with 3 new codes including CMS RVU and

5 collections impact. Deletion of a spine fracture code. Clarification of terms such as percutaneous, endoscopic and open. Changes to spinal steroid injection codes , Bonus: Kim will discuss some common spine procedure coding conundrums including: What s the difference between and The latest on billing a decompression code with an interbody fusion code (22630, 22633). Question and Answer Session Find out about more about Kim Pollock, RN, MBA, CPC, CMDP Consultant and Speaker Click Here to Purchase Orthopedic Spine Coding August 18, 2016

6 We have a billing company for which we bill for many different specialties. We have an orthopedic spine doctor who insists we bill the cage code for each inter-space. However, the CPT book lists as cage(s) therefore our thinking is that no matter how many are placed this code is only allowed one time per surgery. His note states C3-C4, C4-C5, C5-C6 anterior cervical interbody fusion using PEEK titanium interbody spacers. Your client is correct. CPT code is reported per interspace to describe intervertebral biomechanical devices, including PEEK cages. The term is both, single or plural, cage(s), because sometimes there are two devices placed at a single spinal level. If you do an internet search on PEEK cages, you ll find a variety of designs. As long as the supporting documentation in the body of the note is appropriate, the statement above supports 3 units of Remember that this CPT code is not subject to multiple procedure discounts. *This response is based on the best information available as of 08/18/16. TLIF April 9, 2015 I have an operative report where the neurosurgeon performed

7 L5-S1 minimal invasive transforaminal lumbar interbody fusion (TLIF) with L5/S1 and an instrumented fusion (pedicle screws/rods). He did a far lateral transforaminal approach to disc space with left L5/S1 facetectomy and discectomy. He also placed a PEEK cage for the interbody arthrodesis packed with morselized allograft and autograft. The surgeon gave the following codes: 63056, 63047, 22325, 22630, 22840, 22851, and Also, anytime we bill with the code gets denied. Is a modifier 59 appropriate on 22325? I m not sure why always denies as inclusive. I m also questioning code with I m not sure the two should be billed together. Can you help, please? Sure there are a couple of issues here. First, you re right and should not be billed together for procedures performed at the same level. The fracture repair code (22325) includes removing bone fragments and decompression (63047). Do not append modifier 59 to when performed at the same spinal level as That said, your description of the procedure does not support reporting either code, OR And, you re right should not be billed because it is part of the approach to perform the TLIF (22630). Finally, I think you re confusing (structural allograft) with (morselized allograft). So the correct codes are, based on your description: 22630, 22840, 22851, 20930,

8 Bilateral Spinal Instrumentation November 13, 2014 Can I bill the posterior instrumentation codes such as and with modifier 50 because I do put pedicle screws and rods on both sides of the spine? Good try, but no. The spine is considered a central structure for purposes of the instrumentation codes, so it is not appropriate to append modifier 50 to the posterior instrumentation codes. It also is not accurate to append modifier 50 to the anterior instrumentation codes (e.g., 22845) or the intervertebral device code (22851). Exposure for Spine Surgery How Many Levels Can the Co- Surgeon Report? October 2, 2014 I asked my colleague, a vascular surgeon, to provide anterior exposure for an anterior lumbar interbody fusion. At times, this exposure allows for a spine procedure at more than one level. Do we add modifier 62 to all ALIF codes (the first

9 level, 22558, and each additional level, 22585) or just the first level (22558)? Modifier 62 may be appropriately appended to add-on codes (22585) as well as the parent code (22558). If the approach surgeon s exposure is more extensive to accommodate more than the first level anterior lumbar interbody fusion (22558), then s/he may also report the additional levels with modifier 62. Example: a 2 level procedure would be reported as and for the additional level. Remember, the instrumentation codes (e.g., 22845, 22851) and the bone graft codes (e.g., ) may not be appended with modifier 62 according to CPT rules. If the approach surgeon stays for the remainder of the procedure to assist, then the approach surgeon can bill the additional codes with an assistant surgeon modifier such as 80 or 82. Buttress Plate and Screws with a PEEK Device Our neurosurgeon has a coding question regarding placement of an anterior buttress plate/screws placement when it is attached to a PEEK device. He said the vendor rep told him to bill (anterior plate) and (PEEK) even though the screws are only placed on one vertebral body. Is this correct? You are wise to check out this advice. The anterior instrumentation code, 22845, is reported when the plate is a

10 separate device not attached to the PEEK device and can provide independent stabilization on its own. Many of these devices do not meet this criteria so only is appropriate to code.