Clarification provided on ACDF codes, difference between laminectomy codes

ByTeri Romano, RN, MBA, CPC, CMDP

ByKim Pollock, RN, MBA, CPC, CMDP

In this issue of Spine Surgery Today, Kim Pollock, RN, MBA, CPC, CMDP, and Teri Romano, RN, MBA, CPC, CMDP, answer some common, but important coding questions.

– Daniel Refai, MD
Associate Editor, Neurosurgery

Here are a few questions about spine surgery coding that recently came to the attention of KarenZupko & Associates Inc., along with our answers. We hope this information is useful.

Question: Regarding reporting +22851 and +20931, we have been told we cannot bill +22851 and +20931 with the anterior cervical discectomy and fusion (ACDF) code, 22551. Is this true?

Kim Pollock, RN, MBA, CPC, CMDP, and Teri Romano, RN, MBA, CPC, CMDP: It is true if you are thinking about reporting +22851 (Application of intervertebral biomechanical device(s) (e.g., synthetic cage(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)) and +20931 (Allograft, structural, for spine surgery only [List separately in addition to code for primary procedure] at the same spinal level.

For example, you would not use a polyetherether ketone (PEEK) device (+22851) and a structural allograft (+20931) in the same interspace such as at C5-6. 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. An example is a or PEEK device placed at C5-6 and a structural allograft placed at C6-7, although this would be an unusual circumstance.

Question: Please help me understand the difference between codes 63005 and 63047. I do not get it. The codes look the same to me.

Pollock and Romano: We agree this can be confusing because the code descriptions are so similar. However, when you look at the codes carefully, you will see the differences. The Table below, which has the key differences in the code descriptions bolded, should help.

CPT 63005 is generally used for removal of the lamina to provide central decompression of the spinal cord. CPT 63047 involves not only removal of lamina for central decompression, but also lateral recess decompression in the form of a facetectomy (e.g., medial, partial) and/or foraminotomy for nerve root decompression. Be sure you document specifically what you do so the correct code can be chosen. For example, do not say “lateral recess decompression,” but do say “medial facetectomy and foraminotomy for lateral recess decompression.”

Question: My spine surgeon is going to do a T10-S1 fusion and we are trying to figure out the codes for pre-certification. I am unsure about correctly using 22633 with 22610. She is doing a combined interbody and posterolateral fusion (22633) at L4-5 and posterolateral fusions at all the other levels. Do I code 22610 for the thoracic fusion with modifier 59 along with the 22633 code (L4-5, combined fusions) and then code 22614 x 6 units for the other levels?

Pollock and Romano: To precertify this procedure, you will report only one stand-alone code (22633 for the L4-5 combined fusions) and 22614 x 7 units for the additional levels of posterolateral fusion (T10-11, T11-12, T12-L1, L1-2, L2-3, L3-4, L5-S1). It is not accurate to report 22610 with 22633 for the posterolateral fusion at a contiguous level. Do not forget to report the other codes for these procedures, such as for the instrumentation and bone graft.

For more information:
Kim Pollock, RN, MBA, CPC, CMDP, and Teri Romano, RN, MBA, CPC, CMDP, are consultants with KarenZupko & Associates Inc. and serve as faculty members of the American Association of Neurological Surgeons national coding and reimbursement courses. For more information, visit www.karenzupko.com.

Disclosures: Pollock and Romano report no relevant financial disclosures.