Neurosurgery Coding Alert

Don't overlook separately reportable services If you approach arthrodesis claims with dread, it's time to get rid of your fears. Our experts reveal the shortcuts and insider knowledge you-ll need to select the appropriate arthrodesis codes with confidence, every time. Question 1. How Did the Surgeon Do It? The first question you should ask yourself when you pick up a spinal fusion claim is, "Which arthrodesis technique did the surgeon use?" CPT groups arthrodesis procedures into four primary code categories, each of which describes a particular method for achieving spinal fusion: 1. Lateral extracavitary approach technique (22532-22534) 2. Anterior or anterolateral approach technique (22548) 3. Interbody technique (22554-22585 anterior approach and 22630-22632 posterior approach) 4. Posterior, posterolateral or transverse process technique (22590-22614). What to watch for: Most claims you will see will describe either the posterolateral/posterior or interbody technique. Posterolateral or posterior fusion places the bone graft between the transverse processes in the back of the spine, within the facet joints, or along the lamina, says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. The surgeon may then fix the vertebrae in place with screws through the pedicles or facets and/or wire through the facets or spinous processes of each vertebra, which themselves may attach to a metal rod on each side of the vertebrae. Remember: The fixation is separately billable from the arthrodesis. Interbody fusion, in contrast, places the bone graft between the vertebrae in the area usually occupied by the intervertebral disc. In preparation for the spinal fusion, the surgeon will remove the disc nearly entirely. The surgeon may additionally place a prosthetic device (materials include plastic, carbon fiber or titanium) between the vertebrae to maintain spine alignment and disc height. The actual fusion then occurs between the bony endplates of the vertebrae. Once again, Przybylski says, the interbody prosthetic device is also separately billable from the arthrodesis and other instrumentation. Your surgeon's documentation should be explicit on the technique and approach he used. Be aware that in some cases the surgeon may use a "combined" technique (see "Watch for 360-Degree Fusion," page 51). In all cases, if the surgeon's notes aren't explicit, ask for clarification and amended documentation. (Remember: If you can't interpret the operative note, an auditor or claims reviewer will likely not be able to either, if necessary.) Question 2. If Interbody, What's the Approach? Next, if the surgeon performs the arthrodesis using an interbody technique (with the bone graft taking the place of the intervertebral disc), you must further determine the approach the surgeon used. Unlike the other techniques listed above -- in which the approach is integral to the technique -- the surgeon can [...]