Wiki Code Help 22586

[caromissunc1]

Greetings All,
Has anyone else had an issue with codes 22586 and 22851 together? I have had an issue where the payer doesn't want to pay them both because 22851 isn't listed as an applicable add-on code. Is anyone else having this problem?
Thanks!

 

[Jmate]

Can you give us a little more information on the procedure and how the codes are being used?

Thanks

 

[caromissunc1]

My Doc did a fusion at L5-S1. So I coded out 22586, 22851 and 38220 for the bone marrow aspirate. Medicare does not want to pay for both codes because code 22851 was not included in the list of codes that may be used with the mother code of 22586. This code includes disc prep as well as posterior instrumentation. However, it does not list the intervertebral body spacer being utilized (22851). Code 22851 is an add-on code, so I cannot use a 59 with it. As y'all know, instrumentation stabilizes while the fusion is in progress. The intervertebral spacer is what actually gives the vertebrae something to fuse to. Is anyone else having this difficulty?

 

[Jmate]

New CPT codes

Did your physician perform an ALIF, (arthrodesis) 22558 which includes L-5-S-1, or did he do arthrodesis using presacral interbody technique? When I read the full description for 22856 I see the line that states "The procedure inherently includes all effort necessary to perform the fusion procedure." I interpret that to include not just grafts and instrumentation but the spacer as well.
I used both AAOS and AMA 2013 CPT Changes Insiders View And Medrtonic for my information.

If I were you I might consider posing the case to AAOS for definitive clarification on the code definition.

 

[caromissunc1]

It was performed in the prone position. According to the CPT book under 22586, it says: "Arthrodesis; pre-sacral interbody technique, including disc space prep, discectomy, with posterior instrumentation. With image guidance, includes bone graft when performed, L5-S1 innerspace."
I know that the instrumentation cannot be charged separately, but it makes no mention of the intervertebral spacer (22851). The instrumentation is there for stability during the fusion process, but the spacer is what gives the vertebrae something to fuse to. Medicare is not paying. I believe it is an omission in the CPT book.