Neurosurgery Coding Alert

An article in the May 2006 issue of Neurosurgery Coding Alert, -New Fusion Bundles Are Headed Your Way, Thanks to NCCI 12.1,- erroneously cited coding information from Lisa May, CPC, senior charge specialist for Fletcher Allen Health Care in Burlington, Vt. The article stated: -[She] plans to encourage the surgeons in her group to make sure their documentation supports the additional work involved with the interbody fusion to perform the lateral fusion, including documentation of time. She-ll then report both 22612 and 22630, appending modifier 22 (Unusual procedural services) to 22630.-

May actually plans to report just 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar), attaching modifier 22 to represent the extra work involved. Modifier 22 would take the place of code 22612 (Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) now that the National Correct Coding Initiative bundles 22630 into 22612. We apologize to Ms. May for the error.

Bottom line: To clarify, here's how you should code these fusion procedures. For carriers that follow NCCI bundling guidelines, report 22630-59 (Distinct procedural service) and 22612 if the neurosurgeon performs the fusions at different levels.

Use 22612 alone (since it pays more than 22630) with modifier 22 (and an increase in fee) if the physician is doing the interbody fusion at the same level and it adds significant time and effort. For carriers that do not follow NCCI guidelines, you should still be able to report both 22612 and 22630-51 (Multiple procedures) because CPT does not list them as separate procedures.