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Orthopedic Coding Alert

Anatomy:

Straighten Out Your Spinal Coding With These Pointers

Published on Wed Jun 10, 2020

Remember the difference between vertebral segment, interspace.

During her HEALTHCON 2020 presentation “Spinal Surgery Update 2020,” Lynn M. Anderanin, CPC, CPPM, CPC-I, CPMA, COSC, breaks down the basics of spinal anatomy coding, lending some context to the sometimes confusing terms that characterize this tricky part of the body.

Read on for a primer on the basics of all things spinal.

Line Up Body Area With Abbreviations

The best way to learn about spinal anatomy is, unsurprisingly, first knowing the terms and body areas associated with each vertebral set. As a quick reference, Anderanin laid out this chart that she uses to introduce coders to spinal anatomy:

The information in the above table can be an invaluable resource when making sense of encounter notes.

Example 1: Notes indicate that the provider treated vertebrae T1, T2, and T3 in the patient’s lumbar area. Something’s wrong with these notes, as the T spinal segments are thoracic, not lumbar.

Example 2: Notes indicate that the provider treated two coccyx vertebrae in the patient’s tailbone area. These notes make anatomical sense.

Take it from the top: It is useful to know the order that the vertebrae fall along the spine as well, to make sure that you count and catalog segments and interspaces correctly.

From the cervical (neck) area to the sacrum (pelvis) area, the abbreviations are listed thusly:

  • C1-C7
  • T1-T12
  • L1-L5
  • S1-S5.

This information could be a vital lifeline when choosing codes, because it can help you deduce if the encounter notes make sense. If notes indicate that the surgeon treated vertebral discs C2-S1, you might want to check with the provider; this seems a medically unlikely (and huge) area of the spine to treat — it indicates that the surgeon treated nearly 25 vertebrae.

Separate Segment, Interspace Definitions

Anderanin also stressed that coders need solid knowledge of the differences between vertebral segments and vertebral interspaces. Without this info, coding spinal surgeries isn’t going to be easy.

Vertebral segment: This term describes the basic parts into which the spine is divided. The word “segment” represents one complete vertebrae, and includes any related laminae and articular processes, Anderanin explains.

Vertebral interspace: The non-body compartments between vertebrae are interspaces. The intervertebral disc is in the interspace, as are the nucleus pulposus, annulus fibrosus, and a pair of cartilaginous endplates, Anderanin relays.

So, let’s say notes indicate that the surgeon treated vertebrae L1-L3. Just from this information, you can glean the following if you have spinal anatomy smarts:

  • The surgeon treated three vertebral segments: L1, L2, L3.
  • The surgeon treated two interspaces: between L1-L2 and L2-L3.

Check Out This Laminotomy Example

To illustrate her point on anatomy, Anderanin ran the group through some clinical examples to show how to count vertebral segments and interspaces. Here is one of those examples:

Pt has herniated disc L5-S1. Placed pt in prone position, made incision to access spine. Fluoro used to confirm surgical level. Used knife to incise disc, freeing the S1 exiting left nerve root and performing microdiscectomy.

For this encounter, you’d report 63030 (Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar). The surgeon treated a single interspace during this laminotomy: L5-S1.

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