Neurosurgery Coding Alert

Hint: Purpose of the surgery can help you narrow your selection Similarities among vertebral corpectomy, anterior discectomy, partial excision of vertebrae, and osteotomy of spine make choosing among these codes a real challenge. If a difficult operative report overwhelms you, slow down and identify the component steps that distinguish each procedure. Look for Decompression With Corpectomy Your most effective tool to distinguish among spinal procedures is a firm grasp of what each code set includes. For example, anterior vertebral corpectomy, also sometimes called vertebral body resection, involves total or near-total removal of the vertebral body. All vertebral corpectomy procedures include discectomy and can occur either with spinal canal decompression (63081-63091) or with excision of an intraspinal lesion (63300-63308), the latter of which involves decompression of the spinal cord and/or nerve root(s), says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. When reporting vertebral corpectomy with decompression (63081-63091), you should not report fracture care -- which is common with procedures of this type -- separately. You may, however, separately bill for arthrodesis (22548-22812, to stabilize the spine) and spinal reconstruction procedures, including bone grafts (20930-20938) and spinal instrumentation (22840-22855). Example: To treat a compressed nerve caused by fracture, the surgeon performs discectomies followed by corpectomy of segments C4 and C5. She frees compressed nerve roots and reconstructs the spine using a tricortical allograft and titanium plates. Although the surgeon removes only two vertebral bodies, the arthrodesis occurs across three interspaces. The instrumentation involves four segments because the fixation will extend above and below the two reconstructed segments. In this case, you would report: - 63081 -- Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment - +63082 -- ... cervical, each additional segment (list separately in addition to code for primary procedure) - 22554 -- Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 - +22585 x 2 -- ... each additional interspace (list separately in addition to code for primary procedure) - +20931 -- Allograft for spine surgery only; structural - +22846 -- Anterior instrumentation; 4 to 7 vertebral segments. Procedure summary Anterior vertebral corpectomy (vertebral body resection) Code range: 63081-63091 Includes: partial or complete removal of vertebral body, discectomy Purpose: often associated with fracture care (do not report separately) and spinal reconstruction Intraspinal Lesion Calls for 63300-63308
When the surgeon performs corpectomy for an intraspinal lesion -- either with or without decompression (63300-63308) -- you will select a final code according to location (cervical, thoracic, or lumbar or sacral), approach (anterior or anterolateral, transthoracic, thoracolumbar, or transperitoneal or retroperitoneal) and [...]