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Orthopedic Coding Alert

Survive NCCI 9.3:

Bundle Fluoroscopy Into Spinal Surgeries

Published on Thu Oct 02, 2003

The latest version of the National Correct Coding Initiative (NCCI) perpetuates the trend of bundling fluoroscopic guidance into surgical procedures, and this time it's spinal surgery that's under scrutiny.
 
The NCCI version 9.3 additions most likely to affect your practice involve fluoroscopy codes 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 76001 (Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy).
 
These fluoroscopic guidance codes are now considered components of the following spinal surgery codes:
 

  • 22630 - Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar
     
  • 22842 - Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments
     
  • 22851 - Application of intervertebral biomechanical device(s) (e.g., synthetic cage[s], threaded bone dowel[s], methylmethacrylate) to vertebral defect or interspace.

    "The fluoroscopy codes specifically refer to 'physician time,' but if an orthopedic surgeon performs a surgery, and a radiologic technologist performs the fluoroscopy (which is common in most procedures), the surgeon cannot report the professional component of the fluoroscopy," says Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga.
       
    Parman says that this edit was probably enacted because the fluoroscopy is bundled into the physician's supervision. "There is no professional component for 'supervising' the technologist during the procedure," she says.

    The new version of NCCI also bundles 76001 into the following spinal surgery procedure codes:
     

  • 22325 - Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, one fractured vertebra or dislocated segment; lumbar
     
  • 22554 - Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C2
     
  • 22558 - ...lumbar
     
  • 22612 - Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique)
     
  • 25246 - Injection procedure for wrist arthrography
     
  • 26615 - Open treatment of metacarpal fracture, single, with or without internal or external fixation, each bone.
     
    The NCCI 9.3 edits are in effect from Oct. 1 through Dec. 31.

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