Wiki Help with spine surgery coding

sharonc2222

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Looking for proper Medicare coding for the following complicated surgery. Please let me know if any of the anticipated codes I put below would be incorrect, bundled, need modifiers, or if there is anything else should be added or replaced with a more appropriate code.

Patient has chronic back pain, failed back syndrome and adjacent segment disease. Patient was scheduled for TLIF with exploration and also has an existing implanted intrathecal pump. Perhaps someone has access to a program that you can put in the codes and it will you. Greatly appreciate it!

1. Exploration of prior instrumented fusion at L2-L3 (22830)
2. Removal and re-implantation of spinal hardware (22852 & 22849)
3. Revision of intrathecal catheter with laminectomy (62351)
4. Interrogation of intrathecal pump (62367)
5. T11-S1 Posterolateral arthrodesis (T11-T12 22610, T12-L1 22614, L1-L2 22633, L2-S1 22614 x 4) using autograft and allograft (20930. & 20936)
6. Left L1 Osteotomy to decompress left L1 nerve root and correct kyphosis (22214)
7. Right L1 Laminectomy and discectomy, interbody mechanical device placement to decompress right L1 nerve root and correct kyphosis (22633 & 22853)
8. T11 to S1 segmental instrumentation (22843)
9. L5-S1 laminectomy (63005 & 22612)
10. Fluoroscopic guidance, computer navigation (77011, 77003 & 61783).
 
WOW . . . I know you asked this months ago so I'm sure you probably already coded and billed but just in case or if you get a denial here is my take. . .


The following codes are going to bundle into your primary surgical codes: 22830, 22852, 22849,and fluoro.

Fusion T11-S1 - 22612, 22614 x6 (per Karen Zupko you pick your primary fusion code by which level has the most levels involved so, in this case, would be the lumbar spine = 22612)

Posterior segmental (I assume) instrumentation - 22843

I am not sure you can do 22214 and 22633 at the same level b/c they overlap some of the same work like the laminectomy, foraminotomy work. However, CCI doesn't bundle them.

Now if you have 22633 at L1 then you have to discard the 22612 as this will replace it and keep 22614 x6.

22853 correct for cage placement. 20930 & 20936 correct for graft material (we don't bill them b/c almost none of the insurances pay for them including Medicare)

L5-S1 laminectomy - 63005

So in total, it would go something like this:
22633
22214 -51
63005 -59 (this bundles into 22214 & 22633 if done at the same level)
22843
22853
22614 x6
20930
20936
 
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