Neurosurgery Coding Alert

Question: How should I code the following: Left sided thoracoabdominal approach to the lateral aspect of the thoracolumbar vertebrae, T12 vertebrectomy, T11-T12 diskectomy and T12-L1 diskectomy, placement of prosthetic device, a paramesh cage filled with native bone graft, placement of A Z Plate. I coded: 63087, 63088, 22556, 22558, 22851, 20936, 22845. The physician suggested this coding: 63085, 22556, 22851, 20936, 22845.

Montana Subscriber

Answer: Only one level of corpectomy (vertebrectomy) is apparent from the operative description. If only one level was performed, use 63087 (vertebral corpectomy [vertebral body resection], partial or complete, combined thoracolumbar approach with decompression of spinal cord, cauda equina or nerve root[s], lower thoracic or lumbar; single segment) but not 63088 ( ... each additional segment).

Code 22556 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; thoracic) for anterior approach for fusion, 22585 for the additional level of arthrodesis, 22851 (application of intervertebral biomechanical device[s] [e.g., synthetic cages(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace), for the prosthetic device, 20936 (autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar fragments] obtained from same incision) for the local bone graft, and 22845 (anterior instrumentation; 2 to 3 vertebral segments) for placement of the plate.

Note: Individual carriers may have slightly different rules about billing for the additional level of arthrodesis. The anterior fusion codes generally refer to interspaces, and are more appropriate for interbody fusion after diskectomy rather than reconstruction after corpectomy. But, because in this example two interspaces are being addressed during the corpectomy, compensation for the extra level appears warranted.