Neurosurgery Coding Alert

Question: In a patient diagnosed with a tumor at T12, our surgeon adopted a retroperitoneal approach to remove the T11-T12 rib and did a T12 corpectomy for resection of the neoplasm. Would it be appropriate to report 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) since the code descriptor implies a lateral extracavitary approach for a tumor? Alternatively, will it be more appropriate to report code 63090 (Vertebral corpectomy [vertebral body resection], partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root[s], lower thoracic, lumbar, or sacral; single segment) where the descriptor implies retroperitoneal approach but does not indicate tumor?

Alaska Subscriber

Answer: If the incision was performed on the lateral torso, the procedure should be reported with 63090. Code 63101 describes a posterior midline incision in which there is mobilization of the paraspinal muscles to achieve a posterolateral approach to the vertebral body.

This type of procedure is typically associated with a concurrent arthrodesis, which if performed would be reported with 22556 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; thoracic) and +22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression); each additional interspace (List separately in addition to code for primary procedure]) for the T11-T12 and T12-L1 interspaces, as well as anterior spinal instrumentation, which if performed would be reported with 22845.  Other procedures that may be performed include placement of an interbody prosthetic device 22851 and bone grafting.