Wiki Question about Spine Surgery


Houston, TX
Best answers
Good morning my fellow coders,

Spine surgery coding help the doctor performed the procedure below any assistance would be greatly appreciated.

Pedicle screw fixation L5 to S1
Posterolateral arthrodesis L5 to S1 cpt code 22612
Right sided facetectomy and transforaminal lumbar interbody fusion and diskectomy using PEEK spacer, small BMP sponge and cancellous bone chips
L5-S1 laminectomy and bilateral foraminotomies cpt code 63047

Thank you.
Tlif and plf = 22633
peek cage=22853
instrumentation = 22840
cancellous bone chips /graft= 20930

the only way to bill the laminectomy's or laminotomy's with the fusion procedure would be if they were for the sol purpose of decompression. Read the body of the note and it should lead you to the right direction. Hope this helps
clarification on 63047 w/ 22630/22633

Per CMS policy manual, they do not allow 63047 to be billed with 22630 or 22633 if performed on the same interspace; the only payment exception is when done at a space other than where the arthrodesis took place. I contacted NCCI and they confirmed that the XS/XU (etc) modifiers do not override this scenario as they are not appropriate since they are a subset of "59".

Also, most carriers are following this, if they follow NCCI (Their payment policies should indicate this.) There is a CPT Assistant from Oct, 2016 that supports this as well. Hope this clears it up that most payers wouldn't expect to see 63047-59/XS/XU (etc) except for if the work of the 3 components in 63047 is done in a different interspace from what was fused.