Neurosurgery Coding Alert

Question: Recently, I reported a surgery as follows:
22558 22851 22855

The insurer disallowed 22558 as "global," and 22851 was rejected "per administrative policy." What is the problem? Oregon Subscriber Answer: The national Correct Coding Initiative (CCI) considers 22558 (Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; lumbar) to be "mutually exclusive" of 22855 (Removal of anterior instrumentation), implying (incorrectly) that it is unfeasible to remove a spinal fusion and reconstruct it during the same session. And because the spinal fusion was rejected, the prosthetic insertion (22851, Application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) is also denied. If the arthrodesis and spinal fusion were performed at different levels, attach modifier -59 (Distinct procedural service) to the fusion and prosthetic insertion codes to indicate that these procedures took place at a different anatomical area. This will override the CCI edits and allow separate payment for these procedures.

Although your question did not indicate that all three procedures occurred at the same level, this is likely the case. Therefore, it will be difficult to get the medical policy decision needed to override the CCI edits. It is better not to report the instrumentation removal code (22855), which will allow higher reimbursement for the other two codes. If you wish to appeal, however, be prepared to defend your claim to the insurer's medical director. Note: Neurosurgeons and other physicians should work through their respective professional societies, such as the American Association of Neurological Surgeons (AANS), and CMS to eradicate incorrect or unsound CCI edits. For more information, visit the AANS Web site at www.neurosurgery.org/aans or write directly to CMS Correct Coding Initiative, AdminiStar Federal, P.O. Box 50469, Indianapolis, IN 46250-0469.