Wiki Osteotomy for better access, billiable?

[dav5496]

Hello everyone,

I have a spinal surgery that I could use another opinion on. My surgeon performed a L4-L5 arthrodesis, during which he performed an osteotomy of the iliac wing so he could gain better access to the surgical site. I do not feel the osteotomy is billable since there was nothing wrong with the iliac, except for the fact that it was in the way. My surgeon feels this should be billed with CPT 27071 because the surgery would not have been possible without the osteotomy and it took an additional 30 min. I've been having a hard time finding information to support either of our views on this. Below is the osteotomy from the report:


We realized the patient's pelvic is very high that block the access to the L4-L5 space safely. We decided to perform osteotomy of the left iliac wing to obtain a space for the lateral retractor placement. 1 inch osteotome was then used to perform the osteotomy of the iliac wing. We removed about 7 mm of superior iliac wing to obtain save access to the L4-L5 disc space.

 

[MI_CODER]

I'm not an expert when it comes to coding spinal surgeries. However, based on the information you provided, I agree with you and feel that the osteotomy isn't billable.

According to the 2019 NCCI Policy Manual (Chapter 1, pg. 9), "A physician shall not unbundle services that are integral to a more comprehensive procedure. For example, surgical access is integral to a surgical procedure." Further down on page 11, it gives examples of services that are integral to a large number of procedures, which include, "Surgical approach including ... isolation of structures limiting access to the surgical field such as bone..".

You could try billing the main procedure with a modifier 22. However, like I said, I'm not a spinal coder so I'm not sure if documenting that he spent an additional 30 minutes performing the osteotomy would support a modifier 22..

Hopefully some of the other spinal coding experts out there can give you some advice regarding this procedure.

 

[thomas7331]

This is also not my specialty, but I would note that CPT allows for osteotomies of the spine (22206-22208) as an approach in preparation for other spinal procedures. This suggests to me that an osteotomy would not be considered a routine or inclusive component of those types of procedures and the extra work the provider is describing should be billable. I don't think the code suggested is appropriate though, since as you note that is for a pathological condition of the bone. But I would think that an unlisted code or a modifier 22 on the base procedure would be appropriate.