Take Our Multi-Level Spinal Surgery Coding Challenge

Posted on 07. Apr, 2009 by Editor in Hot Coding Topics

AUDIO TRAINING EVENT: Receive Optimum Reimbursement for Spinal Co-Surgeries, with Lynn Anderanin.

Multiple procedures on different spinal levels during the same session not only mean multiple codes but modifiers, too. Make the grade on your next spinal surgery claim by breaking down the following procedure.

Scenario: During a single session, your neurosurgeon performed the following procedures:

• L4-L5 Diskectomy

• L5-S1 Diskectomy

• L4-L5 Transforaminal interbody fusion using posterior interbody technique

• L5-S1 Transforaminal interbody fusion using posterior interbody technique

• Bone graft placement (autograft)

• L4-L5 Interbody cage placement

• L5-S1 Cage placement

• L4, L5, S1 Bilateral pedicle screw instrumentation.

Find Your Solution Piece by Piece

From the description you provide, your surgeon likely performed a “TLIF” procedure, also known as transforaminal lumbar interbody fusion. You should report the following codes for the claim, says Patrice Young, CPC, CMSCS, coder at Commonwealth Orthopaedic Associates Inc. in Reading, Pa.:

If the surgeon performed the L4-L5 transforaminal interbody fusion using a posterior interbody technique, you should report 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar).

For the L5-S1 interbody fusion, you should report +22632 (… each additional interspace [List separately in addition to code for primary procedure]).

You should report the appropriate autograft code (20936-20938) for the autograft.

Bill one unit of +22851 (Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]) to represent the surgeon’s work inserting the interbody cage at L4-L5.

Then, report another unit of +22851 with modifier 59 (Distinct procedural service)...

Tags: +22842, 20936, 20938, 22632, 22851, 63035, multi-level, neurosurgery, orthopedic, spinal surgery, spine, TLIF, transforaminal lumbar interbody fusion