Wiki exposure for disk decompression and fusion with rib


Northeast Kansas AAPC
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Any suggestions would be greatly appreciated!!

Right thoracotomy to provide exposure for neurosurgical disk decompression and fusion with rib.

The patient is undergoing a neurosurgical diskectomy with fusion.l The patient requires exposure fo the vertebrae through the thoracotomoy approach. Request is made by the neurosurgeons to provide exposure. After adequate anesthesia was obtained the patient was placed in the left lateral decubitus position. Using radiologic guidance the appropriate disk space and area required to exposure was marked on the skin by the neurosurgeon to aid in the appropriate exposure. Following this the area was prepped with chlorhexidine and draped in the normal fashion. Posterolateral thoracotomy incision was then make with the knife. The subcutaneous tissue was dissected down to the latissimus which was divided. The serratus was preserved. Athe ribs were counted and dissection was carried out overlying the 6th rib. The peristeoum was elevated off of this and a portion of the 6th rib resected. The lung was allowed to desufflate on the right and the pleural space entered. The lung was retracted medially. The chest was opened with rib retractors and vertebrae identified. Using a spinal needle to mark the disk space and fluoroscopy guidance, the appropriate disk space was identified. We then incised the pleura over thi area and the vertebral bodies above and below the disk space were exposed.

Following this Drs. completed their portion of the procedure with decompressionm and fusion utilizing portions of the rib that were resecte4d. With their portion of the case complete, I was once again called into the room to provide closure. The pleura and itnercostal muscles were closed with a running 2-0 Vicryl suture. The latissimus was closed with a running 0 Vicryl. A 24-french chest tube had been placed through a separate stab incision prior to this. Scarpa's fascia was closed with a running 2-0 suturel, Skin was closed with skin staples. At the time of chest tube placement, we did also place an On-Q med pain pump to provide postoperative analgesia. Occlusive dressing was applied., The patient tolerated the procedure well There were no complications and he was transferred to the recovery room.

Is 32100 the only code the general surgeon can charge for or is there a better CPT code. Two neurosurgeons did the diskectomy so they will get the co-surgery charges. Any suggestions would be appreciated.

I dont necessarily agree with the two neurosurgeons getting the cosurgery fee, they did not do the approach. At best the second neurosurgeon needs to bill his portion with an assist modifier, 80 or 82. Your general surgeon should bill the discectomy code with a 62 because he is doing the approach which is a major portion of the procedure as well as the closure. I am looking at 63077. In the description of the code it states that the thoractomy is not billable separately and there is an edit that prevents separate billing. It actually states "when an anterior approach to the spin is achieved using the skills of two surgeons of different specialties (e.g., a thoracic or general surgeon provides exposure and the neurosurgeon proovides the definitive procedre), this is a co-surgery scenario. Both surgeons report the primary procedure with modifier 62....". If the two neurosurgeons are billing the main code with a 62, they are billing incorrectly because they are not doing all components of the code, approach, definitive portion (the discectomy), and the closure. Your doctor is doing the approach and the closure. I can fax you the page I am looking at in the Neurosurgery coding companion if need be. Usually I call the general surgeon's office in a case like this and discuss the cpt code and diagnosis code with them to make sure we are on the same page with billing to prevent problems with claims and to make sure we are both billing the correct cpt and diagnosis code. If they disagree with you, I would tell your general surgeon to talk to their surgeons because he is really getting shortchanged on reimbursements.