KearstynCPC
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Procedure: Anterior cervical discectomy & Fusion C5
Anterior discectomy for decompression w/fusion C6-7
Placement of biomechanical interbody device C5-6
Placement of biomechanical interbody device C6-7
Anterior Cervical instrumentation C5 through C7
Use of bone allograft
Implants: NuVasive & 4WEB
We are coding this as:
22551, 22552, 22845, 22853 -59 x2, 20930, 76000 -26 -59
According to the Business of Spine Coding Scenarios Handbook this is the correct way to code this procedure.
According to CCI edits, 22853 is allowed with a modifier.
According to CPT book, instrumentation is included in 22853.
Procedure was done in our ambulatory surgery center owned by the rendering provider.
So my question is, can we bill the 22853 with the -59 modifier? Will it be payable?
We received a denial as bundled before adding the 59.
How would you code this!?
Operative Report
The patient was taken to the operative suite and placed supine on the operating room table and was prepped and draped sterily. After anesthesia induction, site mark verification and time out, we brought the C-arm in and localized our incision site. We made a transverse incision over the anterior neck; sharp dissection through skin and subcutaneous down to the platysma. We used monopolar to het through the platysma. Once we got through that, I used blunt dissection to dissect and free up the soft tissue over the sternocleidomastoid and the carotid sheath and its contents down to the prevertebral fascia. One down to the prevertebral fascia, I dissected that with Kittners. We were able to see what I believed was the anterior aspect of C5. I placed a Caspar pin into C5 and confirmed that on a lateral C-arm image. Feeling good about that, I then placed a pin at C7. We then put our self-retaining retractors in. I took a monopolar along the medial aspect of the longus colli on both sides and bluntly reflected those a little bit laterally on both sides to gain good exposure to the disc. We put distraction on the pins, and I incised both discs anteriorly. We started with decompression at C5-6 probably down to about 1 mm to 2 mm. I was able to re establish that out to about 6 mm; same thing at C6-7. Once that was established and all the decompression was done, I packed cages of appropriate size that had been selected, the 4WEB devices. Those were packed with bone allograft and were impacted into position, I trimmed the anterior aspects of the vertebral bodies flush so they could accept a plate. I put a slight, slight bend on the plate to keep it from see-sawing. At that point, I had nice bridging of the anterior discs. I placed screws in all six sites to get dual fixation at all three vertebral segments. Once that was achieved, I removed the Caspar pins, bone waxed those sites, and irrigated the wound. We took final images. AP and later cervical images demonstrated decent position of the implants. It was shifted a little bit to the left side, but nothing was certainly lateral into the uncovertebral area. The lateral had good screw fixation, good screw lengths and positions. We had wrist tightness on all six screws.
We did our final motor testing. Motor evoked potentials were consistent with baseline. There were a couple of trace activities on the vocal cords during the procedure, but nothing that lasted more than a few seconds. Retraction was eased at each of those instances. Somatosensory evoked potentials were fine with baseline as well. We then went back into the wound and did our final locking of the cam mechanism over all six screw. Once that was done, I did a final irrigation. There was no active bleeding in the incision when we went back to it. Based upon the dryness that we encountered, we closed the wound in layers, without deep drain, followed this with skin glue and a sterile dressing. The patient was then able to have anesthesia reversed and go to recovery in stable condition.
Anterior discectomy for decompression w/fusion C6-7
Placement of biomechanical interbody device C5-6
Placement of biomechanical interbody device C6-7
Anterior Cervical instrumentation C5 through C7
Use of bone allograft
Implants: NuVasive & 4WEB
We are coding this as:
22551, 22552, 22845, 22853 -59 x2, 20930, 76000 -26 -59
According to the Business of Spine Coding Scenarios Handbook this is the correct way to code this procedure.
According to CCI edits, 22853 is allowed with a modifier.
According to CPT book, instrumentation is included in 22853.
Procedure was done in our ambulatory surgery center owned by the rendering provider.
So my question is, can we bill the 22853 with the -59 modifier? Will it be payable?
We received a denial as bundled before adding the 59.
How would you code this!?
Operative Report
The patient was taken to the operative suite and placed supine on the operating room table and was prepped and draped sterily. After anesthesia induction, site mark verification and time out, we brought the C-arm in and localized our incision site. We made a transverse incision over the anterior neck; sharp dissection through skin and subcutaneous down to the platysma. We used monopolar to het through the platysma. Once we got through that, I used blunt dissection to dissect and free up the soft tissue over the sternocleidomastoid and the carotid sheath and its contents down to the prevertebral fascia. One down to the prevertebral fascia, I dissected that with Kittners. We were able to see what I believed was the anterior aspect of C5. I placed a Caspar pin into C5 and confirmed that on a lateral C-arm image. Feeling good about that, I then placed a pin at C7. We then put our self-retaining retractors in. I took a monopolar along the medial aspect of the longus colli on both sides and bluntly reflected those a little bit laterally on both sides to gain good exposure to the disc. We put distraction on the pins, and I incised both discs anteriorly. We started with decompression at C5-6 probably down to about 1 mm to 2 mm. I was able to re establish that out to about 6 mm; same thing at C6-7. Once that was established and all the decompression was done, I packed cages of appropriate size that had been selected, the 4WEB devices. Those were packed with bone allograft and were impacted into position, I trimmed the anterior aspects of the vertebral bodies flush so they could accept a plate. I put a slight, slight bend on the plate to keep it from see-sawing. At that point, I had nice bridging of the anterior discs. I placed screws in all six sites to get dual fixation at all three vertebral segments. Once that was achieved, I removed the Caspar pins, bone waxed those sites, and irrigated the wound. We took final images. AP and later cervical images demonstrated decent position of the implants. It was shifted a little bit to the left side, but nothing was certainly lateral into the uncovertebral area. The lateral had good screw fixation, good screw lengths and positions. We had wrist tightness on all six screws.
We did our final motor testing. Motor evoked potentials were consistent with baseline. There were a couple of trace activities on the vocal cords during the procedure, but nothing that lasted more than a few seconds. Retraction was eased at each of those instances. Somatosensory evoked potentials were fine with baseline as well. We then went back into the wound and did our final locking of the cam mechanism over all six screw. Once that was done, I did a final irrigation. There was no active bleeding in the incision when we went back to it. Based upon the dryness that we encountered, we closed the wound in layers, without deep drain, followed this with skin glue and a sterile dressing. The patient was then able to have anesthesia reversed and go to recovery in stable condition.
