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Insertion and bone grafting coding questions answered

ByKim Pollock, RN, MBA, CPC, CMDP

ByTeri Romano, RN, MBA, CPC, CMDP

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In this issue’s Spine Coding Source column, Teri Romano, RN, MBA, CPC, and Kim Pollock, RN, MBA, CPC, continue the discussion on coding challenges and address issues around reimbursement as well.

— Daniel Refai, MD
Associate Editor, Neurosurgery

Daniel Refai

This article will focus on answers to questions related to the most common coding conundrums that spine surgeons face. Accurate coding, especially in spine, is sometimes a challenging and frustrating process. Codes change, as do coding and reimbursement guidelines.

This article includes a sampling of questions we are commonly asked. Watch for more answers to common spine surgery coding and reimbursement questions in future Spine Coding Source columns.

Question: If during a revision surgery, rods and screws are removed at L3-5 and new rods and screws are placed at L2-S1, can both the removal and the new instrumentation be billed?

Teri Romano, RN, MBA, CPC, and Kim Pollock, RN, MBA, CPC: No. CPT guidelines state that only the appropriate insertion code (22840-22848) should be reported when previously placed spinal instrumentation is removed or revised during the same session and the new instrumentation is inserted at levels including all or part of the previously instrumented segments. (CPT Manual 2015).

Teri Romano

Kim Pollock

Question: As part of a posterior spine surgery, bone from the laminectomy and allograft material was used for fusion. Can both bone graft codes be billed? Can they be billed per level fused?

Romano and Pollock: From a CPT coding perspective, each type of bone graft code for spinal surgery (20930-20938) may be reported one time for a spinal procedure, regardless of the number of vertebral levels being surgically fused (i.e., not once per spinal interspace or segment fused). In the case discussed in this question, 20936 (morselized autograft) and 20930 (morselized allograft) would be reported (CPT Assistant January 2004).

Question: What about payment? My coder tells me that Medicare does not pay for 20930 and 20936 with spine fusion.

Romano and Pollock: Your coder is correct. Medicare considers the harvest of morselized autograft from bone in the surgical field (20396), as well as morselized allograft (20930) included in the fusion. Medicare will not reimburse for these codes. However, reporting the harvest of the bone graft materials is appropriate per CPT rules and many private payers reimburse for these procedures. Not billing for these procedures when performed risks a loss of potential revenue from private payers (CPT Assistant January 2004).

Question: After completing a direct lateral interbody fusion, I placed posterior rods and screws percutaneously. What is the proper way to bill for the percutaneous instrumentation placement?

Romano and Pollock: Report this with instrumentation codes 22840-22844 even though the primary procedure was performed through an open minimally invasive approach. The primary procedure and the instrumentation were both performed with direct visualization of the operative field.