Wiki Coding fusion

[icys@aol.com]

I would like to get your opinion in billing this operation, please advice..
Pre op dx: Recurrent l4-5 disc herination and intradural cyst
post op dx: Same as pre op dx
operation performed: L4-5 lumbar transforaminal interbody fusion with instrument with bilateral l4 and l5 pedicle screws, use of autograft, allograft, use of operating microsoft, use of fluoroscopy and fenestration of intradural arachniod cyst.

I have chosen the codes: 22612, 22842, 20931, 20937, 76000 mod 26, 69990.. What do you advice please?
Thank you

 

[penguins11]

There isn't really enough information to give accurate coding but for the fusions, an interbody fusion is 22630, if he also did a posterolateral fusion then it would be the combo code which is 22633. In order to bill for this in addition to placing the pedicle screws he would have to had documented laying down graft in the posterolateral gutter. If he did not document graft in the posterolateral gutter then I would just bill 22630. Usually when they do an interbody fusion they use some sort of cage to hold the graft in the interbody space, if he used a cage this would be 22851. You cant bill for a discectomy with an interbody fusion so there would be no lami code. You cant bill for the fluoroscopy separate either. For the pedicle screws, its only 2 vertebral segments so the correct code is 22840. Would need to know more specifics about what kind of graft to give a graft code. In order to bill for the operating microscope it has to be documented that the operating microscope was brought into the field for microdissection. You can not report 69990 for use of an endoscope or visualization with magnifying loupes or corrected vision. Also, just saw it was a recurrent disc, if the patient had a previous laminectomy at the same sight and a laminectomy is documented in the or for the recurrent disc, for a redo you can bill 63042. I would look at that code to see if the documentation fits as well.

 

[icys@aol.com]

Thanks