Wiki Billing 22551 and 22554?


Howell, MI
Best answers
How would you code a scenario where the surgeon performs a three level ACDF? As we all know the previous way we coded a ACDF that included and discectomy and a fusion would have been 63075 and 22554, with the new codes we now use 22551. However, what do you do in a case where the surgeon does a fusion and a discectomy only on one level say for example C6/C7 and only performs only a fusion on C4/C5 and C5/C6.

Dr coded this a 22551, 22554, 22585

Should we use 22551 with 22585 and end up having to appeal the reasoning of using 22585 rather than 22552 with indication that discectomy was not done at two levels


Code what the Dr used?

Im really confused, please any advice or resources for this situation would be greatly appreciated.
What the dr coded looks like it is correct. Per the description in CPT, you can only use 22585 with 22554, 22556 and 22558 so you are going to have to use the second primary code, (22554). There is a very good chance that you may be asked for documentation so make sure the dr's OR dictation supports all services, in particular make sure the discectomy done at the one level isnt simply for preparation for the interspace. Also, you will need to add a 59 modifier to 22554.