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Diagnosis and size matter when coding corpectomies

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, present the various CPT codes for correctly coding corpectomies. They address the amount of bone removal required for a corpectomy as well as elucidating the fact that the approach and diagnosis also determine the correct choice of the individual CPT codes.

– Daniel Refai, MD
Associate Editor, Neurosurgery 

Daniel Refai

Correct coding of a corpectomy requires knowledge of several factors, including the diagnosis, amount of the vertebral body removed, the region of the spine on which the procedure was performed and the approach. A corpectomy, which is removal of all or part of a vertebral body, is typically performed to decompress the spinal cord which has been compromised due to disease (eg, stenosis, myelopathy, fracture or tumor).

There has been much confusion about and misuse of the corpectomy codes. It is not appropriate to use a corpectomy code, such as 63081, instead of the combined anterior cervical discectomy/decompression code of 22551, if one does not like the reimbursement for 22551.

The corpectomy Current Procedural Terminology (CPT) codes describe a partial or total corpectomy and should be a substantial portion of the body of the vertebra. The CPT Assistant from April 2012, states, “this generally includes removal of a longitudinal portion of the vertebral body to the spinal canal, and may include the posterior longitudinal ligament.” The CPT Assistant article also states a corpectomy code includes the removal of “at least one intervertebral endplate, and may extend to the other unless terminated within the body to secure the end of a strut graft. The amount of bone removal is generally at least one-half of the vertebral body, and is significantly greater than the removal of cortical endplates for an interbody arthrodesis (eg, code 22554). In the thoracic and lumbar spine, the location of bone removed will usually be either lateral or anterolateral because of the restrictions of various approaches to the spine. However, the amount of bone removed will still usually exceed one-third of the mass of the vertebral body, and sometimes comprise the majority of the body.”

Teri Romano

Kim Pollock

The bottom line is to document that a cervical corpectomy involved removal of at least 50% of the vertebral body and at least one-third of the vertebral body in the thoracic or lumbar spine.

The CPT codes used to report corpectomies performed for decompression due to diagnoses such as stenosis, spondylosis, or fracture but not for a lesion are listed in Figure 1 (CPT Codes).

When a corpectomy is performed for an extradural lesion, such as an abscess, tumor or osteomyelitis, the codes in Figure 2 are to be considered depending on the region of spine and the approach performed.

If the lesion, such as an abscess or tumor, is intradural, then consider the codes in Figure 3 (Intradual Lesions).

Lastly, if the approach for the corpectomy is lateral extracavitary, then codes 63101 to 63103 are reported. The lateral extracavitary approach involves a posterior-lateral dissection to the anterior spinal region that allows simultaneous anterior and posterior spinal exposure for decompression and arthrodesis (fusion). A more aggressive exposure is involved and is lateral to the posterior paraspinal muscles as well as dissection of the psoas muscle anteriorly away from the vertebral body. These codes include removal of the posterior spinal structures (e.g., lamina and facet joints) and anterior spinal structures (eg, vertebral bodies and discs) as part of the approach.