22633 and 22612 billed together

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I code for a neurosurgeon that wants to submit 22633 and 22612 during the same surgical session. Is it appropriate to bill these 2 primary procedures together? I was thinking no and that each additional level without an interbody fusion would be 22614.

For example:
Right L4-5 TLIF
L3 to L5 posterolateral arthrodesis

I would submit this as:
22633
22614

Should I be using: 22633 and 22612??

Please help!! I appreciate your time.
 

Mayzoo

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I am still a newbie to this, but here goes my 2 cents.

Parenthetical notes under 22633 state:

"Do not report with 22612 or 22630 at the same level."

So, I would say they cannot be reported together for the same vertebral levels.

22614 parenthetical notes it can be billed "in conjunction with ..... 22633 when performed at a different level". It also states when "performing a combined posterior or posterolateral technique with posterior interbody arthrodesis at an additional level, use 22634."

I would use the 22633, and 22634. I would bet a more seasoned coder will come along though.
 
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22633 when your surgeon does an arthrodesis adopting a posterior approach in a single interspace of the lumbar segment.
22612 is used to report arthrodesis of a single level in the lumbar spine.
do not report 22612 at the same level
 
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I understand that 22633 and 22612 should not be submitted for the same level. And the additional level was not for an interbody fusion so 22634 is not appropriate. I am trying desperately to find something (link to a website) ANYTHING to back up my understanding that only One primary posterior lumbar arthrodesis code can be reported. I place 22633 and 22612 in the compliance checker and they do hit against one another but are acceptable with a modifier. So does this mean reporting 22633 for L4-5 and 22612/59 for L3-4 is appropriate?

I apologize for the long post, I just need to get all my info straight so I can explain to the provider.
 

sarab86

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No you should NOT be billing 22633 and 22612 in the same operative session. You can only have 1 primary Posterior Fusion code. 22633 would be your primary based on the RVUs. Any additional fusion level you need to will use the add-on codes for that fusion technique. They is why the note in CPT says 22614 can be used with 22633.

I would code the case you are explaining as:
22633(L4-5)
22614(L3-4)
Than add your instrumentation
22842
22853
grafts

The same would apply if you have 2+ combo Posterolateral/Posterior Lumbar Interbody Fusion with 2+ additional levels of only Posterolateral technique.
22633
22634(x however many levels of this tech)
22614(x however many levels of this tech)

Many years ago you could use both but that really became an over paid procedure and CPT changes were made for coding rule. AANS has a great coding course for Neurosurgery coding. You can also reach out to KZA that runs the course. They issue out monthly coding coach emails.

I hope this makes sense and helps.
 
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