Intrafacet Implant Doesn’t Bundle Open Approach Arthrodesis
By G.J. Verhovshek, MA, CPC
Category III CPT® codes 0219T-0222T describe a minimally invasive technique for fusion of the spinal facet joints, wherein bone or a device is introduced (percutaneously or by “open” incision) into the facet joint and placement is confirmed using imaging. Discussing these codes, the article “Spine Reimbursement Sees a Major Impact” (April 2012 Coding Edge, pages 22-24) stated:
“… 0220T-0222T include fusion as well as instrumentation, grafting, etc. Prior to this year, these procedures have been coded separately in addition to 22610 and 22612; in 2012, the new codes cover everything.”
This above information was derived from American Medical Association (AMA) guidelines. CPT® code descriptors for 0219T-0222T specify that placement of unilateral or bilateral posterior intrafacet implant(s) includes imaging and placement of bone graft(s) or synthetic device(s). The AMA’s CPT® 2012 Changes: An Insider’s View also instructs, “An exclusionary parenthetical instruction … preclude[s] the use of instrumentation, open approach arthrodesis, and use of spine allograft in addition to the new codes, when performed at the same level.”
Simply stated, 0219T-0222T bundle any associated bone grafting, instrumentation, and imaging at the same level, either unilaterally or bilaterally.
Extensive Arthrodesis Calls for More Granular Coding
Although placement of intrafacet implants can be a minimally invasive procedure, several Coding Edge readers have pointed out that placement of intrafacet implants can also be performed at the same level with more extensive open arthrodesis procedures. In such a case, the open approach arthrodesis (e.g., 22600-22614) is not bundled to the Category III codes 0219T-0222T. Instead, if an open approach is used to perform a posterolateral fusion and placement of intrafacet implants, you would report open approach arthrodesis, rather than 0219T-0222T, as the primary procedure. You may report instrumentation and bone grafting separately, when performed, with an open approach arthrodesis.
For example, a surgeon performs anterior lateral interbody fusion (ALIF) at L4-L5 using a morsalized allograft with placement of PEEK cage. He also documents posterolateral lumbar fusion at L4-L5 and L5-S1 with facet fusion, local bone autograft, and spinous process clamping. Proper coding is:
22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar for ALIF at L4-L5
+22851 Application of intervertebral biomechanical device(s)(eg, synthetic cage(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure) for the PEEK cage at L4-L5
+20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) for the morselized allograft
22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) for the posterolateral lumbar fusion at L4-5, which includes facet fusion (Some payers may require modifier 51 Multiple procedures with this code.)
+22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) for the posterolateral fusion at L5-S1
+20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) for the local bone autograft
22899 Unlisted procedure, spine for the spinous process clamping
Because the facet fusion is inclusive of the posterolateral arthrodesis (22614), you would not report 0221T Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; lumbar.
In a Nutshell
When the surgeon performs minimally invasive placement of intrafacet implants without open approach arthrodesis, report 0219T-0222T, as appropriate. Do not report imaging, bone grafts, or instrumentation separately at the same levels.
When the surgeon places intrafacet implant(s) during open arthrodesis, report the open arthrodesis as primary, along with any necessary bone grafting and the instrumentation placement. Do not report 0219T-0222T in addition to the open arthrodesis.