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Don’t forget to check whether the surgeon used an anterior or posterior approach.

When your surgeon performs an osteotomy, you not only have multiple codes to choose from, but you’ll also need to consider which other services are separately billable along with it. Miscoding these services could cost you significantly, considering the fact that Medicare and most other payers reimburse more than $2,000 per osteotomy.

Check out three key tips that can help you select the most accurate osteotomy codes.

1. Identify the ICD-10-CM Code

Osteotomies are typically performed on patients who have spinal deformities. During the procedure, the surgeon removes part of the spinal bone to correct misalignments. The provider is likely to also use rods and screws to hold the correction in place as it heals.

Payers will reimburse osteotomy claims for a wide range of diagnoses, often including the following, among others:

• M80.08XA (Age-related osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture)
• M80.88XA (Other osteoporosis with current pathological fracture, vertebra(e), initial encounter for fracture)
• M41.35 (Thoracogenic scoliosis, thoracolumbar region)
• M43.04 (Spondylolysis, thoracic region)
• M48.061 (Spinal stenosis, lumbar region without neurogenic claudication)

Always choose the ICD-10-CM code based on the documentation. If the reason that the provider performed the patient’s osteotomy isn’t clear from reading the documentation, query the provider for further details so you can select the correct code.

In addition, always check with your payer to evaluate whether your patient’s condition is covered under its osteotomy policy. Because these are high-value services, most insurers require a pre-authorization before the surgery date, which may require the provider to complete documentation stating the history of the patient’s condition and how it’s affecting their quality of life.

2. Know the Procedure Code Differences

The first step in selecting a CPT^® code is to determine where in the spine the procedure was performed. Then, you’ll count how many vertebral segments were addressed and which approach the surgeon used. Choose from the following codes depending on those factors:

• 22206 (Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic)
• 22207 (…lumbar)
• +22208 (… each additional vertebral segment (List separately in addition to code for primary procedure)
• 22214 (Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar)
• +22216 (… each additional vertebral segment (List separately in addition to primary procedure))
• 22224 (Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar)
• +22226 (…each additional vertebral segment (List separately in addition to code for primary procedure))

You should be able to find the location and number of segments addressed in the operative note. For instance, if the physician refers to the “L3” segment, then they addressed the lumbar spine due to the letter “L.” If they refer to segments “L2, L3, and L4,” then you know they addressed three separate segments in the lumbar spine.

Once you’ve located the osteotomy site and counted the vertebral segments, it’s time to consider the approach. Several codes describe “posterior or posterolateral” approaches, while others refer to an “anterior approach.”

Posterior: During a posterior or posterolateral osteotomy, the surgeon accesses the patient’s spine from the back of their body. This is usually required for conditions such as spinal stenosis, where the surgeon may need to stabilize a large area of the spine.

Anterior: During an anterior osteotomy, the surgeon accesses the patient’s spine from the front of their body. This may be helpful when addressing issues such as bone spurs that are on the inside of the patient’s vertebrae, and thus are more easily accessible from the front.

Finally, you’ll need to know whether any add-on codes apply. If the surgeon addresses additional vertebrae aside from those described by the base code, then report as many units of the add-on code as needed.

For example: The surgeon performs a three-column osteotomy on the T7, T8, and T9 vertebrae to treat a patient’s adolescent idiopathic scoliosis using a posterior approach. For this service, you’ll report 1 unit of 22206 to represent the T7 vertebral segment, and 2 units of +22208 to collect for the T8 and T9 segments. You’ll submit M41.124 (Adolescent idiopathic scoliosis, thoracic region) as the diagnosis code.

3. Report Additional Procedures

Once the surgeon addresses the problematic vertebrae by performing an osteotomy, they may also execute other procedures at the same time. You should always scour the documentation to ensure you don’t miss any additional services that need to be coded separately.

For example: Surgeons almost always perform arthrodesis along with osteotomy so they can fuse the resected section of the spine. If your surgeon documents an arthrodesis procedure, submit a code from the 22590 (Arthrodesis, posterior technique, craniocervical (occiput-C2)) through +22632 (Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (List separately in addition to code for primary procedure)) range.

The code pairs for osteotomy and arthrodesis aren’t typically bundled as part of the National Correct Coding Initiative (NCCI) edits, but always check with your payer to evaluate whether you’ll need to append a modifier to your code pairs.

Torrey Kim, Contributing Writer, Raleigh, NC