AAPC - credentialing the business side of medicine

susie59 · #1 07-03-2012, 07:43 AM

Good Morning,

I am reviewing a charge in our office and have seen this procedure coded several ways. Can someone suggest what the proper coding should be for this surgery?

1. Minimal invasive foraminotomies at L4-L5, and L5-S1 bilaterally
2. Interbody fusion with allograft to bone chips and bone marrow aspirates at L4-L5, and L5- S1.
3. Pedicle screw implantation at L4 to S1 bilaterally.

Any help would be greatly appreciated!

Thank you!

lasheree97 · #2 07-03-2012, 08:26 AM

Good morning, These codes should help you out

1. Depending if the foraminotomy is for disc herniation use 63030 (each add'l level 63035)if its for stenosis I would use 63047(each additional level 63048)

2. Interbody Fusion:22612,22614 each add'l level;allograft (for bone aspirates)20930
3. Pedicle screw fixation 22840 single level;22842 for 3-6 levels.
I hope this helps or guides you. Have a blessed day!

susie59 · #3 07-03-2012, 10:21 AM

Thank you so much for your response, I will share this with our billers.

Have a great afternoon!

mtimson · #4 07-03-2012, 01:57 PM

I do agree, however 22612 is Posterior Lateral fusion not interbody.

PLIF -- Posterior Lumbar Interbody Fusion 22630 & 22632 (addn level)

As far as the Laminectomy you have to be sure that this was done for decompression not just for disk removal (63030), otherwise its included in the PLIF.

Also what did they use for the interbody device? Was it a Cage? 22851 would be the code for that if this is what the allograft was placed inside of.

~Hope this helps!
Marty

penguins11 · #5 07-11-2012, 06:42 AM

I agree with the 22630 and 22632 and I the laminectomy was done for decompression, stenosis you would bill per nerve root, 63047, 63048. Discectomy is included in the code so you cant bill 63030. For the bone marrow aspirate you can bill 38220. For the graft, if it is morselized you would use 20930, if structural you can use 20931. 22842 would be correct for the instrumentation. Double check the OR and see if he did a posterolateral fusion too, (if he laid graft in the posterolateral gutter), in addition to the interbody fusion. If he did a posterolateral in addition to the interbody, you would bill 22633 and 22634 instead of 22630 and 22632.