Neurosurgery Coding Alert

Hint: -Multiple procedure- rules don't apply to same-session arthrodesis, bone grafts To get the most out of your spinal instrumentation claims, you must consider procedures beyond placement of the instrumentation itself. In part 2 of this two-part series, we discuss four more ways you can ensure accurate and complete instrumentation coding, every time. 1. Don't Forget Additional Procedures You should use +22848 (Pelvic fixation [attachment of caudal end of instrumentation to pelvic bony structures] other than sacrum [list separately in addition to code for primary procedure]) to describe fixation of the distal (or caudal, "closer to the tailbone") portion of posterior instrumentation to the pelvis. This may occur, for instance, to correct scoliosis extending to the pelvis (which causes the pelvis to tilt). Code 22848 applies regardless of whether the surgeon attaches segmental or non-segmental instrumentation. Important: You should report 22848, like all instrumentation codes, in addition to a primary procedure code, says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta. CPT 2008 provides a full list of procedures with which you may claim 22848. Also, +22841 (Internal spinal fixation by wiring of spinous processes [list separately in addition to code for primary procedure]) describes a secondary posterior procedure in which the spinous process (the bony prominence projecting rearward from the vertebra) of two or more vertebral segments are wired together (for instance, to promote fusion of bone grafts). Medicare bundles this service, so you will not receive separate reimbursement for it. 2. Don't Apply Modifiers for Initial Surgery You should not append modifiers 50 (Bilateral procedure) or 51 (Multiple procedures) to codes describing spinal instrumentation. Here's why: CPT defines instrumentation procedures as inherently bilateral, so you should never use modifier 50, Parks say. In addition, all codes describing placement of instrumentation (22840-22848, 22851) are exempt from multiple-procedure (modifier 51) adjustments, according to CPT. Explanation: Because a surgeon would never report instrumentation alone (at minimum, he would also perform arthrodesis), the value assigned to these add-on codes already takes into account their status as "additional" but independent procedures. "Instrumentation codes-are valued for -intraoperative- work only," says Annette Grady, CPC, CPC-H, CPC-P, CCS-P, compliance auditor at The Coding Network. "There is no preoperative or postoperative work value. Therefore, they must be reported with a primary code, such as arthrodesis, but may also be reported with fracture and/or dislocation or exploration of fusion codes as well." Nor would you report modifier 59 (Distinct procedural service) with spinal instrumentation codes, except to denote different levels for cage placement, as explained in part 1 of this series (Neurosurgery Coding Alert, Vol. 8, No. 11, pp. 81-83). 3. Do Apply Modifiers for Follow-up Surgery When reporting follow-up instrumentation procedures during the [...]