Wiki Another discontinued procedure - cervical fusion

[martnel]

I coded 22554-74, but the insurance (workers comp) says that code is not reflected in the report. Did I just pick the wrong code or what? This is in an ASC setting.


NAME OF OPERATION: Anterior cervical disc fusion at C5-6 and C6-C7.

INDICATIONS FOR THE PROCEDURE: Mr. xxxxxx was brought to the operating room for anterior cervical discectomy with fusion with allograft and plate placement through the microscope.

DESCRIPTION: After being induced with anesthesia, he had a difficult airway and we were unable to get him intubated. We were unable to do his anterior cervical surgery. He will be rescheduled in the hospital under awake fiberoptic innervation.

 

[RebeccaWoodward*]

I do have a question. CPT code 22554 is defined by CMS as an inpatient code only (status C). You're allowed to perform these in an ASC setting?

 

[martnel]

Yes, we are, only for certain insurance companies, NOT Medicare. (It depends on the contracts we have.

 

[RebeccaWoodward*]

Interesting. I learned something new today.

By the way...I agree with your code. 22554 is correct for an anterior cervical fusion.

 

[mbort]

you may have to use the 73 modifier rather than the 74 since the patient was not actually intubated.

hope this helps
Mary, CPC, COSC

 

[mitchellde]

Check the code with your state work comp fee schedule. I have done a lot of work comp in a lot of different states and it was my main research project in grad school. Work comp in each state sets the rules, they can determine which version of CPT they follow. so if you are using 2009 codes and they ise say 2000, then you could be using a code that is not in their recognized code set. Just an idea.

 

[martnel]

you may have to use the 73 modifier rather than the 74 since the patient was not actually intubated.

hope this helps
Mary, CPC, COSC

Mary, I just talked to the Anesthesiologist this morning and he says the intubating is irrelavant when determining if anesthesia was administered. Not all patients get intubated, only if they need like a airway or something. In this case, anterior cervical fusion, the mask was going to be in the surgeons way, so the patient needed to be intubated for an airway. He says anesthesia was defintely administered, which leaves me with the 74 modifier.