Neurosurgery Coding Alert

Modifier -59 can still provide for separate billing, when necessary

If you're billing arthrodesis, you should expect to collect less reimbursement for related procedures from Medicare and other payers that follow the National Correct Coding Initiative (NCCI) edits. 1. Avoid Same-Day Excision/Corpectomy Reporting You should no longer report thoracic vertebral body excision code 22112 (Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root[s], single vertebral segment; thoracic) with vertebral corpectomy code 63101 (Vertebral corpectomy [vertebral body resection], partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root[s] [e.g., for tumor or retropulsed bone fragments]; thoracic, single segment). NCCI version 11.1 (effective April-June, 2005) now bundles these procedures.

NCCI also includes edits that apply to the corresponding lumbar codes. In other words, 22114 (Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root[s], single vertebral segment; lumbar) is now a component of 63102 (Vertebral corpectomy [vertebral body resection], partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root[s] [e.g., for tumor or retropulsed bone fragments]; lumbar, single segment).

"The edit bundling 22114 into 63102 makes sense because the two procedures are so very close in description," says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J. "You should report 22112 for partial excision of the vertebral body without decompression, while the corpectomy codes include decompression."

You can unbundle: Because these edits include a "1" indicator, you can use modifier -59 (Distinct procedural service) to unbundle the codes in the rare case that the surgeon performs the corpectomy and excision separately (for example, on separate vertebral segments).
 
2. Review Your Arthrodesis Claims You'll also want to check your claims carefully if you perform arthrodesis, because NCCI 11.1 bundles 11 additional codes into both 22532 (Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace [other than for decompression]; thoracic) and 22533 (... lumbar). The bundles include:
  Instrumentation removal 22850, 22852, 22855
   Spinal fixation device reinsertion 22849
  Debridement 11010-11012
  Exploration 22830
  Diskectomy-related procedures 62287, 62290, 72295. Once again, you can override the edits with modifier -59 if the surgeon performs separate and distinct services. For example, if the surgeon performs arthrodesis and places instrumentation at a different spinal level, you are warranted in coding for both procedures.