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Wiki 22633 with 63277

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JYSPA

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My physician did a 63277 (removal of mass) at L4 and 22633 (interbody fusion) at L4-L5 as that area was also very degenerated.

He is saying that as both were distinc and separate, both can be billed. My manager agrees that the lesion (mass) is separate and per 59 guideline "a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)", it qualifies. Therefore, 59 modifier can be used.

Any opinions?
 
The medical record documentation for the operation and the decision making process prior to the surgery would the deciding factor. Did he know ahead of time he would do the fusion? Or once he was in the OR, and the DDD was noted to be so bad that this decision was then made to perform the fusion, then I could see coding for both procedures. Or add modifier 22 to the primary procedure with detailed explanation on why it was a longer than normal surgery. As always, the devil is in the details.....document, document, document.
 
63277

63277 is a Laminectomy code. If a fusion was performed to replace the bone removed a fusion code 22612 would be efficient and justifiable for reimbursement.
63277
22612-59
 
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