Question Answer - AAPC

1 QuestionAnswerWhat 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 : 1) is 62310-50 77003 x 2 appropriate coding, 2) 64483 64484 72275 x 2 appropriate coding, and 3) is 64622 64623 77003 x 2 appropriate coding? 77003 has a medically unlikely edit that it can only be reported once. 72275 is reported by spinal region, so in your case if you are in the lumbar area so you should only report 72275 once is it appropriate to use codes 22630 & 63042 in the same setting?

2 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, you code laminectomies by segment or interspace? It depends on what laminectomy you are performing. The description of the code will describe whether to use interspace or vertebral 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) 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 is the CPT code for a pulsed intercostal radiofrequency ablation?

3 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 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 codeI love Lynn. What a great teacher. Thanks for the kind 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 I do not believe you need to report the 76 modifier on the add on codes for spine.

4 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 you bill the tranpendicular and costovertebral approach for the same level63055 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 was taught that when a deompression and fusion is done at the same level insurance will deny unless radiculopathy is the dx for the decompression and to use a 59 mod not 51. I believe this contradicts what you said earlier. Please clarify Normally, the 59 modifier is used to note different levels.

5 A decompression and fusion at the same level would then need a 51 modifier because it is at the same you code a T10 pulsed radiofrequency ablation using 64620 or 64999?There currently is no code for pulsed radiofrequency. The AMA is stating that 64999 should be used and it is not appropriate to use 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 Because the opening is included in 22558, the cardiovascualr surgeon should report the 22558 with a 62 modifier as well as the spine surgeonis a percutaneous disectomy the same as a kyphoplasty? 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 balloonI coded a surgery using 63075, 63076, 22551, and 22552.

6 The 22551 and 22552 was not paid saying payment adjusted because this procedure/service is not paid separatley. What am I doing wrong? 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 setting?According to CMs Physicians Fee Schedule there is a facility and non-facility fee. Insurance carriers may have their own an injection of lumbar (L4) 64483 (L5-S1) 64484, 64484-59 is this coded correct?

7 Then when its bilateral how is it coded. Pls. to the CMS Relative Value file these procedures can be billed as bilateral, so each CPT code can be reported with modifier 50, and don't forget to double the need proper coding for the ASPEN or AXEL devices pleaseAnswer: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?0275T is more than likely the current code for this effective July 1, 2011. Please review this CPT Category III code with the billing spinal tumors with instrumentation do you use 22612 and 22614 and 22842 or do you use 63295.

8 Answer : Per the CPT guidelines listed under 63295 in the CPT manual you should be only using 63295 with 63172, 63173, 63185, 63190, using 63290 do you bill 22614 and 22842 or 63295 for the instrumentation after removing the tumor. Please see the guidelines in the CPT manual after 63295 for code is appropriate for a revision of a laminectomyThe 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 billing 63042 in order to report does it have to be a re-rupture of a disc that was operated on previously? It does not have to be re-ruptured to report this 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?

9 ? Answer : This is not a spine coding Question , however see G0412 for the code to report this to Medicare Is there any difference in coding MIS for fusion codes?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 # 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? 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?

10 Another co worker and I do not agree on this. Provider performed laminectomy at T9, T10, T10 with uninstrumented fusion with autograft at T9-T10 & T10-T11. Any suggestions is greatly appreciated. Loving this webinar as well. Very informational!!! 63265 can be used as long as a laminectomy was necessary to be able to reach and remove the abcess and that is the specific reason why the laminectomy was performedWhat do you use for sacroplasty and what would you use for repairing the sternum, similarly when it does not heal from surgery? There are Category III codes for sacroplasty, 0200T and 0201T, but not 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 is it appropriate to bill 63047 and 22551 together and would you use a modifier?