Test your spine coding knowledge

In this issue’s Spine Coding Source column, Teri Romano, RN, MBA, CPC, CMDP, and Kim Pollock, RN, MBA, CPC, CMDP, have provided a quiz to clarify coding challenges. We hope this provides valuable education to our readers through pertinent clinical vignettes.

– Daniel Refai, MD

Associate Editor, Neurosurgery
 

It can be complex and confusing to accurately code spine procedures. As a number of codes may be appropriate for each procedure, it is essential to get them right. Over-coding risks an audit and under-coding means less revenue than you may legitimately deserve. Both of these outcomes are undesirable in today’s health care reimbursement climate.

This Spine Coding Source column includes a quiz that was developed to test an individual’s spine coding knowledge through some common spine coding scenarios. Take the test and evaluate the accuracy of your coding skills.

Case #1

Diagnosis: Lumbar stenosis.

Procedures:

1. L4-5 laminectomies, medial facetectomies, foraminotomies for decompression.

2. L4-5 posterolateral fusion with local bone graft.

Which codes are most appropriate to use?

A. 22612, 63047-51 and 20936.

B. 22612, 63047-51, 63048 and 20936.

C. 22630, 63047-59 and 20936.

D. 22630, 63005 and 20936.

Case #2

Diagnosis: Severe stenosis, foraminal stenosis and spondylolisthesis, L4-S1.

Procedures:

1. Laminotomy with bilateral discectomy and facetectomies, L4-5 and L5-S1.

2. Posterior interbody fusion L4-5, L5-S1 (transforaminal lumbar interbody fusion or TLIF).

3. Posterolateral fusion L4-S1.

4. Segmental instrumentation with pedicle screws and rods, L4-S1.

5. Polyether ether ketone devices placed bilaterally at L4-5 and L5-S1.

6. Local bone graft and morselized allograft L4-S1.

Which codes are most appropriate to use?

A. 22633, 22634, 63047-59, 63048, 22842, 22851 x 2, 20936 and 20930.

B. 22633, 22634, 63047-59, 63048, 22842, 22851 x 4, 20936 and 20930.

C. 22633, 22634, 22842, 22851 x 2, 20936 and 20930.

D. 22633. 22634, 63030, 63035, 22842, 22851 x 2, 20936 and 20930.

Case #3

Diagnosis: Cervical spondylosis with myelopathy, C5-C7.

Procedures:

1. C5-7 anterior cervical discectomy, decompression and fusion.

2. Placement of machined, structural allograft bone.

3. Placement of an anterior cervical plate.

4. Use of the microscope with microdissection.

Which codes are most appropriate to use?

A. 22551, 22845 and 22851.

B. 63075, 22554, 22845 and 20391.

C. 22551, 22552, 22845, 22851 and 20931.

D. 22551, 22552, 22845 and 20931.

Case #4

Diagnosis: C4 burst fracture.

Procedures:

1. Total corpectomy C4.

2. Discectomies C3-4, C4-5.

3. Placement of expandable cage C3-5.

4. Local autograft.

5. Placement of anterior plate C3-5.

6. Use of operating microscope.

7. Intraoperative fluoroscopy.

Which codes are most appropriate to use?

A. 63081, 69990, 63075, 63076, 22845, 22851 and 20936.

B. 63081, 69990, 22554, 22585, 22845, 22851 and 20936.

C. 63081, 69990, 22845, 22851, 20936 and 76000-26.

D. 63081, 22326, 69990, 22845 and 20936.

Check the answers

Case #1: The correct answer is A. 22612, 63047-51 and 20936.

Rationale: A single-level posterolateral fusion (22612) with autograft (20936) was performed with a decompression for stenosis (63047). Modifier 51 is appended to the lower-valued code (63047). There are no bundling issues.

Case #2: The correct answer is C. 22633, 22634, 22842, 22851 x 2, 20936 and 20930.

Rationale: The two-level combined interbody and posterolateral fusions (22633, 22634) were performed with intervertebral devices at each interspace (22851 x 2 units as this code is reported per interspace, not by the number of devices at each interspace). The segmental instrumentation of three vertebral segments L4-S1 (22842) and autograft harvest (20936) and allograft (20930) use are all separately reported. Separate foraminotomies with decompression of the nerve roots (63047, 63048) are not documented. A discectomy (63030, 63035) is included in 22633 and 22634.

Case #3: The correct answer is D. 22551, 22552, 22845 and 20931.

Rationale: A two-level anterior cervical discectomy and fusion or ACDF (22551, 22552) was performed with a structural allograft (20931) and an anterior plate (22845). CPT 22551 is a global code that includes 63075 and 22554. A structural allograft is reported using 20931, not 22851 for an intervertebral device. Fluoroscopy is included in all open spine procedures and not separately reported with a code, such as 76000.

Case #4: The correct answer is B. 63081, 69990, 22554, 22585, 22845, 22851 and 20936.

Rationale: A single corpectomy for fracture (63081) includes the discectomies above and below the corpectomies (63075, 63076). Fusion of the interspaces (C3-4 and C4-5) is reported as 22554 for the first interspace and 22585 for the second. The microscope used for the corpectomy is separately reported (69990) as is the local autograft (20936). The expandable cage (22851) and an anterior plate (22845 for three vertebral segments) are also reported. The open fracture treatment code (22326) is specifically for a posterior approach and is not accurate for an anterior fracture reduction. Intraoperative fluoroscopy is included in open spine procedures.

How did you do?

Those who scored less than 100% should take some time to review spine codes and make a point to attend specialty-sponsored coding courses on a regular basis. For additional information, visit the KarenZupko & Associates website at www.karenzupko.com for biweekly and archived coding questions and answers.

• For more information:
• Teri Romano, RN, MBA, CPC, CMDP; and Kim Pollock, 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: Romano and Pollock report no relevant financial disclosures.