Anterior cervical diskectomy icd 10 procedure code

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1 Home Anterior cervical diskectomy icd 10 procedure code Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance. Aetna considers lumbar decompression with or without discectomy medically necessary for rapid progression of neurological impairment (e.g., foot drop, extremity weakness, numbness or decreased sensation, saddle anesthesia, bladder dysfunction or bowel dysfunction) confirmed by imaging studies (e.g., CT or MRI). Aetna considers cervical, thoracic and lumbar laminectomy and fusion experimental and investigational for all other indications not listed above as medically necessary because of insufficient evidence of its effectiveness for these indications. Spinal fracture, dislocation (associated with mechanical instability), locked facets, or displaced fracture fragment confirmed by imaging studies (e.g., CT or MRI); or. Spinal tumor, primary or metastatic to spine, confirmed by imaging studies (e.g., CT or MRI), which may be combined with a laminectomy; or. I believe you would bill for the reinstertion of hardware since the hardware is going back at the same levels. at not the Note: Medical records must document that a physical examination, including a neurologic examination, has been performed by or reviewed by the operating surgeon. Greater than 50 % compression fracture of vertebrae, or. Member's activities of daily living are limited by persistent pain. Spinal stenosis graded as moderate, moderate to severe or severe (not mild or mild to moderate) with unremitting pain confirmed by imaging studies (e.g., CT or MRI) that has failed 6 weeks of conservative management Footnotes * when any of the following is met: Symptomatic moderate or greater central canal stenosis caused by vertebral body pathology (such as due to fracture, tumor or congenital or acquired deformity of the vertebral body). stenosis causing severe weakness (graded 4 minus or less on MRC scale (see appendix));. Decompression is performed in an area of segmental instability as manifested by gross movement on flexion-extension radiographs; or. Spinal stenosis (central,

2 lateral recess or foraminal stenosis) graded as moderate, moderate to severe or severe (not mild or mild to moderate) with unremitting pain, with stenosis confirmed by imaging studies (e.g., CT or MRI) at the level corresponding to neurological findings, where symptoms have failed to respond to six weeks conservative therapy Footnotes * (unless there is evidence of cord compression, or other indications for waiver of requirements for conservative management, noted below); or. The deformity is associated with severe neck pain, difficulty ambulating, and interference with activities of daily living; or. Decompression is performed in an area of segmental instability as manifested by gross movement on flexionextension radiographs; or. Imaging studies (e.g., CT or MRI) indicate central/lateral recess or foraminal stenosis (graded as moderate, moderate to severe or severe; not mild or mild to moderate), or nerve root or spinal cord compression, at the level corresponding with the clinical findings; and. Symptomatic unremitting pain that has failed 3 months of conservative management Footnotes * (unless there is evidence of cervical cord compression or other indications for waiver of requirements for conservative management, noted below); or. As noted in CPT 2012, "Only the appropriate insertion code ( ) 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 instrumented segments. Do not report the reinsertion (22849) or removal (22850,22852,22855) procedures in addition to the insertion of the new instrumentation ( ).". causing spinal cord or nerve root compression with unremitting pain, confirmed by imaging studies (e.g., CT or MRI) and with corresponding neurological deficit, where symptoms have failed to respond to six weeks of conservative therapy Footnotes * (unless there is evidence of cord compression, or other indications for waiver of requirements for conservative management, noted below) or. Member's activities of daily living are limited by persistent pain radiating from the back down to the lower extremity; and. This 55-year-old patient was diagnosed with posterior lumbar disc disease of 2 discs along with radiculopathy. To correct his condition, he underwent a partial excision of the two lumbar discs, followed by a posterior lumbar spinal fusion at L1-L3 with a BAK cage (Bagby and Kuslich), an interbody fusion device. The spine was approached from behind (posterior), not from the front (anterior) and the approach was open. An autologous bone graft was taken from the hip. Psychological and psychiatric evaluation and testing ( ICD-9-CM V3. Step 1: Locate the correct section in your PCS coding book. You know that

3 surgery was performed, so the most logical selection is the Med/Surg section. The first character in this section is always 0. Only parts of the disc are removed, not the entire disc. Therefore, it is considered an excision rather than a resection. CERVICAL PROCEDURES PHYSICIAN CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) Anterior interbody fusion, with discectomy and decompression; cervical below C first interspace Surgery and other procedures involving the heart ( ICD-9-CM V , ICD-10-PCS 02 ). Text is available under the Creative Commons Attribution-ShareAlike License. Indexing in process. Check back for further updates. Wikisource has original text related to this article:. 0RG13JJ Fusion of Cervical Vertebral Joint with Synthetic Substitute, Posterior Approach, Anterior Column, Percutaneous Approach. consists of the anterior longitudinal ligament, the anterior annulus, and the anterior portion of the vertebral body. The. 00 alteration; 01 bypass; 02 change; 03 control; 04 creation; 05 destruction; 06 detachment; 07 dilation; 08 division; 09 drainage; 0B excision; 0C extirpation; 0D extraction; 0F fragmentation; 0G fusion; 0H insertion; 0J inspection; 0K map; 0L occlusion; 0M reattachment; 0N release; 0P removal; 0Q repair; 0R replacement; 0S reposition; 0T resection; 0U supplement; 0V restriction; 0X transfer; 0Y transplantation. Vertebrae and intervertebral discs: see Template:Bone, cartilage, and joint procedures. American Hospital Association. AHA Coding Clinic for ICD-10-CM and ICD-10-PCS 3 (Third Quarter 2014): 30. L2-L3 posterolateral/posterior arthrodesis with locally harvested morcellized autograft and BMP. As with Examples #1 and #2, the segmental instrumentation is included in the spinal fusion and is not coded separately. The lumbar decompression L4-L5 and L5-S1 bilateral foraminotomies and L3 decompression laminectomy are also considered to be integral to the spinal fusion and not coded separately. Bone graft may be packed inside the implant. Any autologous and/or nonautologous graft material (e.g., bone graft, morselized bone, or demineralized bone matrix) used is included in the interbody fusion device with a device value 'A'. Incision made in front of the spine through a minilaparotomy or laparoscopy. surgery and other procedures ( ICD-9-CM V , ICD-10- PCS 1 ). 0RG14K1 Fusion of Cervical Vertebral Joint with Nonautologous Tissue Substitute, Posterior Approach, Posterior Column, Percutaneous Endoscopic Approach. Step 7: Determine if there are any qualifiers. Yes, the qualifier is posterior approach but this one is tricky. As discussed previously in the comments section of 10C, the 7 th character would be J Posterior Approach, Anterior Column. We now have a final code, 0SG10AJ. Anatomy: The structure of the

4 spine is considered to be composed of the anterior, middle, and posterior columns. The. For tumors involving one or more vertebrae, or. Symptomatic unremitting pain that has failed 3 months of conservative management Footnotes * (unless there is evidence of cervical cord compression or other indications for waiver of requirements for conservative management, noted below); or. Member has failed at least 6 weeks of conservative therapy (see note below) (unless there is evidence of cervical cord compression, which requires urgent intervention); and. Spinal infection confirmed by imaging studies (e.g., CT or MRI) and/or other studies (e.g., biopsy), which may be combined with a laminectomy; or. Subaxial (C2-T1) instability confirmed by imaging studies, when both of the following are met:. stenosis causing severe weakness (graded 4 minus or less on MRC scale (see appendix));. Imaging studies (e.g., CT or MRI) indicate central/lateral recess or foraminal stenosis (graded as moderate, moderate to severe or severe; not mild or mild to moderate), or nerve root or spinal cord compression, at the level corresponding with the clinical findings; and. Data on the long-term outcomes of the Charite Artificial Disc comes from France, where the artificial disc has been in use for more than a decade. David (2000) reported in abstract form on a retrospective review of the outcome of 92 patients with chronic low back pain who were implanted with the artificial disc. The investigators reported "excellent or good" results in 75% of patients after a minimum of 5 years follow up, with no disc space height loss and no loosening or expulsion of the core. Lemaire, et al., described their 5-year and 10-year results with the Charite Artificial Disc. In the paper reporting on 10-year results, Lemaire, et al. (2002) reported an excellent or good outcome in 90% of 100 patients with a return to work rate of 91.6%. In addition, the investigators reported no subluxations or core expulsions, a reoperation rate of 5% and a 2% rate of adjacent-level disc disease. The mean flexion/extension range of motion was 10.3 degrees, with a mean lateral bending motion of 5.4 degrees. Correct only the insertion is covered and should be reported only even if the previous instrumentation was removed. Symptomatic pseudarthrosis (non-union of prior fusion), which is associated with radiological (e.g., CT or MRI) evidence of mechanical instability or deformity of the thoracic spine that has failed 3 months of conservative management Footnotes * (unless there is evidence of thoracic cord compression, or other indications for urgent intervention, noted below); or. Note: Medical records must document that a physical examination, including a neurologic examination, has been performed by or reviewed by the operating surgeon. Aetna considers FDA-approved

5 prosthetic intervertebral discs (e.g., Bryan Cervical Disc, MOBI- C, the Prestige Cervical Disc, ProDisc-C Total Disc Replacement, Secure-C Artificial Cervical Disc) medically necessary for the treatment of skeletally mature persons with symptomatic cervical degenerative disc disease or herniated disc at 1 or 2 contiguous levels from C3 to C7, when all of the following criteria are met: Aetna considers lumbar prosthetic intervertebral discs (e.g., the activl Artificial Disc, the Charite Artificial Disc, and the ProDisc-L Total Disc Replacement) experimental and investigational for lumbosacral degenerative disc disease and for all other indications. Presence of neck or cervico-brachial pain with findings of weakness, myelopathy, or sensory deficit; and. van Ooij et al (2003) reported a series of 27 patients who presented with unsatisfactory results or complications after Charite disc replacement. Most patients were operated on at the L4 - L5 and/or the L5 - S1 vertebral levels. The patients were evaluated with plain radiography, some with flexion-extension x-rays, and most of them with computed tomography scans. The group consisted of 15 women and 12 men. Their mean age was 40 years (range, years) at the time of operation. The patients presented to the investigators a mean of 53 months (range months) following disc replacement surgery. In two patients, an early removal of a prosthesis was required and in two patients a late removal. In 11 patients, a second spinal reconstructive salvage procedure was performed. Mean follow-up for 26 patients with mid- and long-term evaluation was 91 months (range months). Early complications were the following: In one patient, an anterior luxation of the prosthesis after 1 week necessitated removal and cage insertion, which failed to unite. In another patient with prostheses at L4 - L5 and L5 - S1, the prosthesis at L5 - S1 dislocated anteriorly after 3 months and was removed after 12 months. Abdominal wall hematoma occurred in four cases. Retrograde ejaculation with loss of libido was seen in one case and erection weakness in another case. A temporary benefit was experienced by 12 patients, while 14 patients reported no benefit at all. Main causes of persistent complaints were degeneration at another level in 14, subsidence of the prosthesis in 16, and facet joint arthrosis in 11. A combination of pathologies was often present. Slow anterior migration was present in two cases, with compression on the iliac vessels in one case. Polyethylene wear was obvious in one patient 12 years after operation. In eight cases, posterior fusion with pedicle screws was required. In two cases, the prosthesis was removed and the segment was circumferentially fused. These procedures resulted in suboptimal long-term result. Spinal infection confirmed by imaging studies (e.g., CT or MRI) and/or other studies (e.g.,

6 biopsy), which may be combined with a laminectomy; or. Spinal fracture, dislocation (associated with mechanical instability), locked facets, or displaced fracture fragment confirmed by imaging studies (e.g., CT or MRI), which may be combined with a laminectomy; or. Once a year we have a meeting with a coding consultant. A question was posed asking if removal of instrumentation could be billed in addition to new instrumentation if performed at adjacent levels during the same operative session. The example given was removal of previously placed posterior instrumentation at L4-5, and placement of new instrumentation at L5-S1. The answer given was no, this is not separately reported and the appropriate code is only. Central/lateral recess or foraminal stenosis graded as moderate, moderate to severe or severe (not mild or mild to moderate); and. The study sponsor considered the study a success if the overall success rates of the two treatment groups were non-inferior, i.e., the difference in overall success rates (i.e., non-inferiority margin) is no greater than 15 %. However, the FDA requested that the data also be analyzed and reported using a non-inferiority margin of 10 %. As noted in CPT 2012, "Only the appropriate insertion code ( ) 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 instrumented segments. Do not report the reinsertion (22849) or removal (22850,22852,22855) procedures in addition to the insertion of the new instrumentation ( ).". All other reasonable sources of pain have been ruled out; and. Aetna considers lumbar partial disc prosthetics (e.g., Nubac, DASCOR Disc Arthroplasty System) experimental and investigational because of insufficient evidence of their effectiveness.

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