Wiki 22633 Coding Question

[heidibeggan]

Hi! I need a 2nd opinion with this coding scenerio. Specifically # 2 and #4 below. I know you cannot code 22612 with 22633. In # 2, does reaming and shaving the L4 segement count for the posterolateral arthrodesis in code 22633? If so would #4 be coded 22614 x 2 for segments L2 and L3 OR would one of the segments in #4 count towards #2 code 22633? Sorry if this is confusing. Thanks in advance for any help!

Op Procedure:

1. Complete bilateral lumbar laminectomy, medial facetectomy and decompression of the nerve roots at L2, L3 and L4. (MD Coded 63047, 63048 x 2)

2. Arthrodesis inside the disc space anteriorly at L3-L4 on the left side with reaming and shaving, along with the L4 segments. (MD Coded 22633)

3. Placement of interbody fusion in the form of synthetic Peek CAGE. (MD Coded 22851)

4. Posterolateral arthrodesis at 2 segments L2 and L3. (MD Coded 22612, 22614)

5. Spine stabilization with Zimmer Spine Pedicle Screw system with 2 screws at the L2, 2 screws at the L3, 2 screws at the L4, connected with the rod, locking nuts tightened together. (MD Coded 22842)

 

[onetwothree]

The procedure codes 63047 and add on code 63048 are components of 22633. The code 22633 includes lamenectomy, If you still want to bill all codes, bill like this, 63047,63048,22633,59 and add on codes 22842 and 22851. Do not code #4. #2 and #4 are the same. I hope it helps. Don't be surprised if they dnies codes 63047 and 63048.

 

[SJMarra]

63047 is included in the 22633 code if it is done to prepare the space for the fusion. If the laminectomy is done to decompress the nerve root and is over and above what is typical for the PLIF, then yes you can code for it. You will need a -59 modifier on the 63047. It may still get denied the first time, but as long as the doctor dictates that the lami is done for the decompression, they should pay on appeal.

 

[SJMarra]

22633 includes the lami if it is done to prepare the space, if the lami is done for decompression and is documentated then you can bill for it with a -59 modifier. Code 22633, 22614 63047-59, 63048, 22842 and 22851. Cannot use 22612 as it would be duplicate code.