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What is the difference in the codes 63075 and 22551

63075 only covers a decompression and 22551 covers the decompression

and arthrodesis. If the decompression and arthrodesis are performed at

the same operative session, 22551 must be used rather than 63075 and

22554

Our physician requested that we ask the following coding/billing question: 77003 has a medically unlikely edit that it can only be reported once.

1) is 62310-50 77003 x 2 appropriate coding, 2) 64483 64484 72275 x 2 72275 is reported by spinal region, so in your case if you are in the lumbar

appropriate coding, and 3) is 64622 64623 77003 x 2 appropriate coding? area so you should only report 72275 once also.

When is it appropriate to use codes 22630 & 63042 in the same setting?

do you code laminectomies by segment or interspace?

This is very controversial but you should be able to report it if the physician is removing lamina or disk on the anterior side of the spine from a posterior approach to make space for instrumentationn, cages, grafts, etc. It depends on what laminectomy you are performing. The description of the code will describe whether to use interspace or vertebral segment.

what modifier can we use for a corpectomy (L3-L4)and posterolateral fusion done on same day. The corpectomy was done after the posterolateral (L1-S1) What is the CPT code for a pulsed intercostal radiofrequency ablation?

If I am understanding your question, the corpectomy is performed at a different level than the fusion. In general, the modifier 59 is reported to note different levels. There currently is no code for pulsed radiofrequency. The AMA is stating that 64999 should be used and it is not appropriate to use 64600-64681.

If there is a procedure for t12 and L1 (two diff parts) but connecting would the procedures related be 51 or 59

I love Lynn. What a great teacher. can a 4 level bilateral interbody fusion with 4 peek cages be coded lumbar 22612 , 22614, 22614-59, 22614-76-59 to prevent a duplicate denial and can the peed cage be coded 22851 x 4 on one line

When crossing over spinal areas you should not use two primary codes, but use the additional level codes. The primary code in this case would be the T12, and the additional level would be reported with the additional level code Thanks for the kind words. I do not believe you need to report the 76 modifier on the add on codes for spine. You might want to look at 22630, 22632 for interbody fusion. 22851 can only be reported once per level, so in this case if a cage is placed in each interspace, it can be reported x 4.

can you bill the tranpendicular and costovertebral approach for the same level

63055 and 63064 are not a CCI edit however the CPT code descriptions basically describe the same procedure. It would have to be proved as medically necessary in the documentation, and may still be a problem.

I was taught that when a deompression and fusion is done at the same Normally, the 59 modifier is used to note different levels. A

level insurance will deny unless radiculopathy is the dx for the

decompression and fusion at the same level would then need a 51

decompression and to use a 59 mod not 51. I believe this contradicts what modifier because it is at the same level.

you said earlier. Please clarify

Would you code a T10 pulsed radiofrequency ablation using 64620 or

There currently is no code for pulsed radiofrequency. The AMA is stating

64999?

that 64999 should be used and it is not appropriate to use 64600-64681.

what code would the cardiovascular surgeon use when he merely opened up the patient for us to do a fusion?? i do not want to give this surgeon the fusion code of say 22558 is a percutaneous disectomy the same as a kyphoplasty?

I coded a surgery using 63075, 63076, 22551, and 22552. The 22551 and 22552 was not paid saying payment adjusted because this procedure/service is not paid separatley. What am I doing wrong?

Because the opening is included in 22558, the cardiovascualr surgeon should report the 22558 with a 62 modifier as well as the spine surgeon

A percutaneous discectomy is the removal of disc, a kyphoplasty is a percutaneous procedure to repair vertebral fractures by insertion of cement through a needle with balloon 22551 and 22552 inclued 63075, 63076 and need to be reported when the discectomy and fusion are performed at the same session. 63075 and 63076 are only reported if only a discectomy is performed. If your surgeon is performing this with another surgeon performing the fusion, both phyisicians must report the 22551 and 22552 with modifier 62

Can the kyphoplasty and vertebroplasty ever been performed in the office According to CMs Physicians Fee Schedule there is a facility and non-facility

setting?

fee. Insurance carriers may have their own policies.

if an injection of lumbar (L4) 64483 (L5-S1) 64484, 64484-59 is this coded According to the CMS Relative Value file these procedures can be billed as

correct? then when its bilateral how is it coded. Pls. help.

bilateral, so each CPT code can be reported with modifier 50, and don't

forget to double the price.

we need proper coding for the ASPEN or AXEL devices please

Answer:There is currently no code for the ASPEN device and it should be

reported with 22899. I suggest prior authorization because some

insurance carriers may consider it experimental and/or investigational.

CIGNA does. For the AXLE device, I am not familiar with that one.

how would the endoscopic disectomy be coded in the lumbar area?

when billing spinal tumors with instrumentation do you use 22612 and 22614 and 22842 or do you use 63295.

When using 63290 do you bill 22614 and 22842 or 63295 for the instrumentation after removing the tumor. what code is appropriate for a revision of a laminectomy

0275T is more than likely the current code for this effective July 1, 2011. Please review this CPT Category III code with the physician. Answer : Per the CPT guidelines listed under 63295 in the CPT manual you should be only using 63295 with 63172, 63173, 63185, 63190, 6320063290. Please see the guidelines in the CPT manual after 63295 for instructions.

The only codes that refer to reexploration are 63040-63044. If these are not appropriate, see the laminectomy codes. If you utilize a laminectomy code other than 63040-63044 you may be able to report a 22 modifier if there is enough complexity to the procedure and it is documented.

when billing 63042 in order to report does it have to be a re-rupture of a disc that was operated on previously? We have been getting denials for CPT code 27215 by Medicare - this is a valid code in CPT but not on MDCR fee schedule - what are your thoughts on open tx of fx for this?? Is there any difference in coding MIS for fusion codes?

On the example with the 22558 with a 62 modifier, what if your spine surgeon has an Assistant? Can they bill for the 22558-AS in order to be able to bill the add on codes performed by the spinal surgeon and the assistant surgeon, not by the cardiovascular surgeon?

It does not have to be re-ruptured to report this code.

Answer : This is not a spine coding question, however see G0412 for the code to report this to Medicare

It depends on the physicians definition of MIS. If it is endoscopic, there are the new Category III codes effective July 1, 2011. See presentation slide #35. most insurance carriers will only reimburse for a co-surgeon or an assistant per code. If you are billing 22558 with a 62 for the cardio surgeon performing the approach, most carriers will not allow an assistant also, but you could report the additional levels with the AS modifier because you wouldn't have to report these with a 62

Would you use 63266 for an epidural abscess? Another co worker and I do 63265 can be used as long as a laminectomy was necessary to be able to

not agree on this. Provider performed laminectomy at T9, T10, T10 with reach and remove the abcess and that is the specific reason why the

uninstrumented fusion with autograft at T9-T10 & T10-T11. Any

laminectomy was performed

suggestions is greatly appreciated. Loving this webinar as well. Very

informational!!!

What do you use for sacroplasty and what would you use for repairing the There are Category III codes for sacroplasty, 0200T and 0201T, but not

sternum, similarly when it does not heal from surgery?

these are percutaneous and may be considered experimental and

investigational. For the sternum repair, please refer to 21750. This may be

what you are looking for.

When is it appropriate to bill 63047 and 22551 together and would you use These procedures are anterior and posterior so a modifier 59 would be

a modifier?

used if I assume correctly that two incisions are made.

If we are billing 22558-62 for our spine surgeon, even knowing that most Good point. I would suggest that you report the primary code with no

carriers won't cover an assistant charge, if we don't bill it than the add on charge attached. That may help. Only my suggestion.

codes are denied for the assistant as they are being billed without a

primary procedure code. Any thoughts?

can we report 22849 and 22855 together? we are not getting reimbursed They are a CCI edit so many insurance carriers will consider the removal

but slide 33 says we can bill them??

included in the reinsertion at the same session. Check with your carriers

on whether they follow CCI.

On a TLIF our surgeons perform both an interbody fusion (22630) as well as You should be able to but sometimes difficult to get reimbursed. This is

a posterolateral fusion (22612). Are both of these codes reportable?

very controversial but you should be able to report it if the physician is

removing lamina or disk on the anterior side of the spine from a posterior

approach to make space for instrumentationn, cages, grafts, etc.

When do you use modifier 80? is 63047 appropriate to use for a revision of a laminectomy can you use a 80 modifier at a teaching facility

Does Medicare reimburse Category III procedure codes?

Modifier 80 is used when a physician is the assistant surgeon and there are some insurance carriers that want the 80 modifier instead of AS for non physician practitioners. Yes, when 63040-63044 are not applicable. Assistants are not normally accepted at a teaching facility because it is expected that residents are used for the assistants at surgery. If a resident is not available for some reason, it has to be clearly documented in the operative report why a resident was not utilized, and modifier 82 should be used. They will reimburse only some. Please check with your local carrier. The general rule of thumb is that if it is listed in an LCD or in the fee schedule, it will be reimbursed based on the medical necessity

Could you expalin the guidelines for the difference between codes 63075 and 22554?

Effective in 2011 you cannot report 63075 and 22554 anymore but must report 22551 and 22552. You can only report 63075 and 22554 if one or the other are performed, but not together

Thank you for including the additional questions in the Q & A. Does Medicare reimburse Category III codes?

how can you appropiatley code a cervical disc replacement acdf 1 or 2 level? what code is appropriate for a revision of a laminectomy

You are welcome.

They will reimburse only some. Please check with your local carrier. The general rule of thumb is that if it is listed in an LCD or in the fee schedule, it will be reimbursed based on the medical necessity

22856 and 0092T. Currently, most insurance carriers will only reimburse this at one level. Additional levels are considered investigational and experimental There is one group of codes for re-exploration 63040-63044. If these are not appropriate use the regular laminectomy codes.

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