Wiki Removal of C3-4 Anterior spurs

[sdunaway1]

Our doctor is going to perform a Removal of C3-4 Anterior spurs with a possible C3-4 ACD&F and removal of C4-5 plate. The patient has a previous C4-5 ACDF from 2009. The payer is Medicare.

I feel that the codes should be for the removal of c3-4 ant spurs only:
22830- exploration
22855??? - removal of spurs?? I cannot find a code for removal of spurs only


for the removal of spurs @ C3-4 and ACDF w removal of C4-5 plate:
22551
22845
22855
20931

Can I please get opinions on this coding?

 

[penguins11]

I wouldn't bill for exploration of fusion because he is not exploring the previous fusion. he is removing spurs from the level above the previous fusion. If he only removes the previous plate and removes the spurs I would bill for the 22855 and either a miscellaneous code 64999 in which you will have to submit the OR along with a letter stating what procedure the code is most like so the insurance has something to base the reimbursement off of. If he removes the spurs and does part of the work for an anterior discectomy but does not remove disc, I would bill the 22855 and code 63075 with a reduced services modifier 52 to indicate all of the procedure was not done. Again a letter of explanation and the OR will have to be submitted.

If he does the fusion, I would bill 22551, 22845 and 20931. You can not bill for the removal of plate if any common vertebra are involved, in this case he would be removing the plate affixed at C4 and putting on a plate at C3-C4. Because the same vertebra is involved you cant bill for removal. If the plate was being removed at C5-C6, you could bill for removal because the same vertebra is not involved in the procedure. This is a recent change Medicare has enacted in regards to instrumentation.