Wiki Removal Anterior Cervical Osteophytes C2-C4

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DButcher

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Does Anyone have any thoughts on how to code this? I was looking at 63075 but that does not feel right.



PREOPERATIVE DIAGNOSIS:
Anterior osteophytes causing dysphagia at C2, C3 and C4.

POSTOPERATIVE DIAGNOSIS:
Same.

OPERATION:
1.* Removal of anterior osteophytes* at C2.
2.* Removal of anterior osteophyte* at C3.
3.* Removal of anterior osteophyte at C4.

EBL:* Minimal.

COMPLICATIONS:* None.

DISPOSITION:* Stable to recovery.

ANTIBIOTICS:* Two grams Ancef given 30 minutes prior to skin incision.

INDICATIONS:* The patient is an 84-year-old gentleman complaining anterior
dysphasia.* On CT scan and MRI, it was found that he had significant
osteophyte formation at C2, C3, C4.* Because
of this, we discussed about continuing nonoperative measures versus surgical
treatment, the patient elected for surgery.* He understood the general risks
of surgery not inclusive, but including bleeding, infection, anesthesia,
dysphagia, dysphonia, as well as nerve damage and neurovascular complaints.

BRIEF OPERATIVE COURSE:* Patient was met and greeted in preoperative holding. *
Patient had opportunity to ask all questions, all questions were answered. *
Patient was brought to the operating room.* Patient underwent general
anesthesia.* Timeout was performed.* Next, a longitudinal incision was made on
the left side of the neck.* We used a standard Smith Robinson approach, we
encountered a huge anterior osteophyte.* Using C-arm, we took down the anterior osteophytes* *
at C2, C3 and C4.* We palpated to make sure it was nice and flush.* Once it
was, we got C-arm to confirm that we had removed the anterior osteophyte and
it showed that we had removed with a significant amount of bony spurs.* Next,
we irrigated.* We placed bone wax to help with bleeding as well as help with
recurrent formation.* Once we were happy with that, we placed a drain exiting
the skin and we closed the fascia as well as the platysma with 2-0 Vicryl, 3-0
Monocryl.* I was present and participated in the entire case.
 
DButcher said:
Does Anyone have any thoughts on how to code this? I was looking at 63075 but that does not feel right.



PREOPERATIVE DIAGNOSIS:
Anterior osteophytes causing dysphagia at C2, C3 and C4.

POSTOPERATIVE DIAGNOSIS:
Same.

OPERATION:
1.* Removal of anterior osteophytes* at C2.
2.* Removal of anterior osteophyte* at C3.
3.* Removal of anterior osteophyte at C4.

EBL:* Minimal.

COMPLICATIONS:* None.

DISPOSITION:* Stable to recovery.

ANTIBIOTICS:* Two grams Ancef given 30 minutes prior to skin incision.

INDICATIONS:* The patient is an 84-year-old gentleman complaining anterior
dysphasia.* On CT scan and MRI, it was found that he had significant
osteophyte formation at C2, C3, C4.* Because
of this, we discussed about continuing nonoperative measures versus surgical
treatment, the patient elected for surgery.* He understood the general risks
of surgery not inclusive, but including bleeding, infection, anesthesia,
dysphagia, dysphonia, as well as nerve damage and neurovascular complaints.

BRIEF OPERATIVE COURSE:* Patient was met and greeted in preoperative holding. *
Patient had opportunity to ask all questions, all questions were answered. *
Patient was brought to the operating room.* Patient underwent general
anesthesia.* Timeout was performed.* Next, a longitudinal incision was made on
the left side of the neck.* We used a standard Smith Robinson approach, we
encountered a huge anterior osteophyte.* Using C-arm, we took down the anterior osteophytes* *
at C2, C3 and C4.* We palpated to make sure it was nice and flush.* Once it
was, we got C-arm to confirm that we had removed the anterior osteophyte and
it showed that we had removed with a significant amount of bony spurs.* Next,
we irrigated.* We placed bone wax to help with bleeding as well as help with
recurrent formation.* Once we were happy with that, we placed a drain exiting
the skin and we closed the fascia as well as the platysma with 2-0 Vicryl, 3-0
Monocryl.* I was present and participated in the entire case.
Click to expand...

Look at 22110, 22116. Here's a link with more descriptive info of this code range:

https://www.optum360coding.com/upload/pdf/ATUE14/ATUE14.pdf


HTH!
 
I know this is an older post, but I have a similar op report where the physician describes resection of anterior vertebral osteophytes from C3- C6 vertebral bodies. He documents partial corpectomies with resection of greater than 50% of the vertebral bodies and decompression of the posterior esophagus. He did not remove the discs above and below the vertebra.
The post above recommends using 22110, and I've found a few older articles supporting this. However, I came across a 2022 Neurosurgery Coding alert that states 22110 is for "excision of an intrinsic bony lesion...not for degenerative arthritic changes like osteophytes."
Does anybody have updated information supporting the use of 22110 in this scenario, or should I be looking at unlisted?
 
I think it would be fine to use 22110. There is no CPT or CPT-A guidance that would prohibit it.

A corpectomy is removal of the entire vertebral body, or at least a significant majority of it - it is a massive procedure and would require insertion of a large fusion cage to support the anterior column - if that WASN'T done, it is NOT a corpectomy. You cannot reasonably do a corpectomy without supporting and fusing the spine. A spine surgeon I am aware of was doing wedge debridements of the vertebral body and documenting >50% but when you look at the size of the cage used and look at post-op x-rays, it was clear that it was not a corpectomy. That surgeon has had to repay hundreds of thousands of dollars to both CMS and third party payors. I would be highly suspect of corpectomy coding and most would consider it fraudulent to use in that context.
 
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