Neurosurgery Coding Alert

Neurosurgery claims for spinal instrumentation (22840-22848) are being reduced and denied because of inappropriate actions by carriers and lack of coder knowledge. This confusion results from misunderstanding that spinal instrumentation codes are secondary and cannot be billed on their own.

Five Steps to Increase Pay Up Potential

1. Properly bill co-surgeries. A major problem arises when billing for the installation of instrumentation with co-surgeons. Sharon Tucker, CPC, president of Seminars Plus, a medical coding and billing consulting company based in Fountain Valley, Calif., explains that, In the operating room, one doctor may perform the primary procedure and fusion while the other handles the instrumentation. Under these circumstances, they both must work together when billing. If the primary surgeon bills separately for the arthrodesis (22612), while the second bills for the instrumentation (22842), the second physicians claim will likely be denied, because instrumentation codes cannot be billed on their own. They are only reimbursed when they are billed together with a primary procedure.

Tucker suggests both physicians bill as co-surgeons for the primary procedure using modifier -62 (two surgeons). The doctor who is responsible for installing the instrumentation would bill that code without a modifier as well. Both should write detailed, complete operative notes that document distinct roles. Alternately, the physician who performs the instrumentation could bill as an assistant for the primary procedure using the -80 modifier (assistant surgeon), plus the code for the instrumentation.

Coders should work closely with their neurosurgeon and the other physicians staff to develop a coding plan that reflects both contributions to ensure appropriate reimbursement for all parties.

2. Understand carrier criteria for choosing spinal instrumentation codes for vertebral segments and vertebral interspaces.

These rules of thumb below will prevent carriers from down coding or delaying your payments due to confusion over how many levels of spinal instrumentation were inserted into the patient.

Codes for segmental instrumentation are based on the number of segments spanned. For instance, 22842 covers three to six segments, while 22843 covers seven to 12, and 22844 covers 13 or more.

Instrumentation is never coded alone, so the use of modifier -51 (multiple procedures) is not necessary.

Occasionally, a metal cage or other prosthetic device is placed for stabilization in an area where a large portion of the vertebra has been removed. It is usually filled with an acrylic resin called methyl methacrylate. When more than one cage is placed in the same intervertebral space at the same level, use 22851 (application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace) just once. When cages are placed at more than one level, indicate by number of units on [...]