Wiki Help with Spine coding

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Rvoigt

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Hi all,
I am trying to properly code a spinal surgery and the doctor and I are discussing the codes and have a difference of opinion. Some of the codes he wants to use are bundled so I am hoping there codes we can replace them with? Here is what he performed. Any help is much appreciated!
SURGICAL PROCEDURE:

1. Left-sided L5-S1 laminotomy and decompression.

2. L4, L5, S1 pedicle screws, Synthes USS.

3. Left-sided L5-S1 transforaminal interbody fusion with allograft prosthetic spacer and local allograft.

4. L4, L5, S1 pedicle screws and posterolateral fusion with local autograft, allograft, Chronos, and demineralized bone matrix.

5. Harvest local autograft

6. Intraoperative neuromonitoring by ____.
He wants to bill:
22633
22612
22632
22842
22851
63030
20930
20936
 
Rvoigt said:
Hi all,
I am trying to properly code a spinal surgery and the doctor and I are discussing the codes and have a difference of opinion. Some of the codes he wants to use are bundled so I am hoping there codes we can replace them with? Here is what he performed. Any help is much appreciated!
SURGICAL PROCEDURE:

1. Left-sided L5-S1 laminotomy and decompression.

2. L4, L5, S1 pedicle screws, Synthes USS.

3. Left-sided L5-S1 transforaminal interbody fusion with allograft prosthetic spacer and local allograft.

4. L4, L5, S1 pedicle screws and posterolateral fusion with local autograft, allograft, Chronos, and demineralized bone matrix.

5. Harvest local autograft

6. Intraoperative neuromonitoring by ____.
He wants to bill:
22633
22612
22632
22842
22851
63030
20930
20936
Click to expand...

I'm coming up with (provided that the op report supports documentation for everything you listed above):

22633 (L5-S1 decomp & combined posterior/interbody fusion)
22614 (L4-5 posterior fusion)
22842 (L4-S1 posterior instrumentation)
22851 (L5-S1 interbody cage
20930 (allograft)
20936 (autograft)

I don't agree with 22612 or 22630, as they are components of 22633. Same for 22632 as an add-on, since I only see 1 interbody fusion, which would be part of 22633. I'm using 22614 because there is a notation beneath it in the CPT book that it can be an add-on level for 22633.
So in a nutshell, the primary code 22633 is the combined fusion at L5-S1, the add-on 22614 for the posterior-only fusion at L4-5.

HTH some!!
 
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