Follow CPT Guidelines To Report Multilevel Spinal Surgeries Properly
Published on Tue Jan 01, 2002
CPT codes are written to reflect current medical practices, which do not always lend themselves to simple explanations or formulaic reductions. On occasion, this can lead to inconsistencies in which codes describing superficially similar procedures are reported in distinctly different ways. For example, surgeries involving multiple spinal segments or interspaces may be reported using a combination of primary procedure and add-on codes, "multilevel" codes that cover a specified number of segments/interspaces (e.g., "one or two vertebral segments") or a single, "regional" code that applies regardless of the number of segments/interspaces involved. Modifier application can also differ from case to case.
'Each Additional' Codes
The most familiar method employed by CPT to report multilevel procedures is add-on codes that specify "each additional segment" or "each additional interspace," says Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno. Such codes are always reported in addition to a primary procedure code for the initial spinal segment or interspace.
For example, 63300-63307 describe excision of intraspinal lesions by vertebral corpectomy, i.e., partial or complete resection of the vertebral body. The surgeon selects the appropriate code according to location (cervical, thoracic or lumbar), incision depth (extra- or intradural) and approach (cervical, transthoracic, thoracolumbar, or transperitoneal or retroperitoneal). Each of these codes specifies single segment in its descriptor and applies only to the initial spinal segment at which the corpectomy is performed. Any additional segments beyond the first are reported using add-on code 63308 (... each additional segment [list separately in addition to codes for single segment]) regardless of the location, depth of incision or approach.
Consider a case in which the surgeon excises an extradural intraspinal lesion via a partial corpectomy of cervical vertebrae C2 and C3, Sandham says. Corpectomy at the first vertebra (C2) is coded 63300 (vertebral corpectomy [vertebral body resection], partial or complete, for excision of intraspinal lesion, single segment; extradural, cervical), while corpectomy at the second vertebra is coded 63308.
If more than one additional segment had been involved in the example, multiple units of 63308 would have been reported. For instance, if corpectomy was required at all levels from C2 to C5, the procedure would be reported 63300 (for vertebral segment C2) and 63308 x 3 (for segments C3, C4 and C5).
Note: According to CPT, modifier -62 (two surgeons) may be applied to 63300-63307 "when two surgeons work together as primary surgeons performing distinct part(s) of an anterior approach for an intraspinal excision" as well as to 63308 "as long as both surgeons continue to work together as primary surgeons." When submitting a claim with modifier -62 attached, each surgeon must provide his [...]
