Spinal fixation

[mkndevh@msn.com]

Does anyone know what types (i.e. PEEK) spinal fixation biomechnical devices (cages) require a plating system for stabilization? I code for anesthesia only and can't bill the new 22853, 22854, or 22859 because they don't hold any base units for anesthesia. We only can bill the plating systems if they're NOT an integral component of the cage. Normally op reports aren't specific enough to confirm if plate is truly a separate device or just being used for anchoring. Other than reaching out to the surgeons for each case I was trying to research and find info on what components the biomechnical devices include. Any ideas? TIA!!

 

[julyagroves]

Fixation

In my experience (I work with a group of spine surgeons,) cages would not typically require a plate. Some surgeons will attach screws to the cage to avoid plating in an ACDF situation. Other surgeons will usually use a cage and a separate plate to give additional fixation. I also see use of different types of devices and there is really no hard rule. I would try and inquire with the coder at the surgeon's office to get clarification if you possibly can.
I have had several issues with the new codes getting paid so far this year. Many payers are not yet able (even though it is April,) to accommodate the new codes.

 

[mkndevh@msn.com]

Thank you!!!! In most cases then do you use the CPT for the cage (i.e. 22853) in addition to the CPT for the plate fixation (22845)?

 

[amyjph]

You would want to check with the provider or look at the op note to find out the manufacturer and type of hardware/devices being used. This can help you determine if the intervertebral spacer is integral to a plate or if the plate is stand-alone. For example, in our practice I know that we never use combination spacer/plate devices so they are always separate.

The AAOS/Karen Zupko has good information on this.

https://www.karenzupko.com/new-spinal-cage-codes-2017/

 

[mkndevh@msn.com]

Thank you!

 

[julyagroves]

Fixation cont.

Thank you!!!! In most cases then do you use the CPT for the cage (i.e. 22853) in addition to the CPT for the plate fixation (22845)?

Yes, we do.

 

[julyagroves]

Please note

Please take note that as of 4/1/2017 CMS has bundled codes 22845 with 22853 so you need to make sure there is a 59 modifier if your physician does a plate as well as a cage.

 

[eutsler]

22845 and 22853 both billable?

I have a related question. I work for the general/vascular surgeon who performs the approach, then stays on to assist.

The other surgeon's report says "Annulectomy followed by diskectomy and decompression was performed with resection of posterior annulus and bilateral foraminotomies. This allowed for 14 mm height 11 degree lordotic PEEK prosthesis combined with bone morphogenetic protein and local bone graft. Anterior Synthes titanium instrumentation was used spanning L5 and S1. The 6.2 x 25 mm screws were utilized."

The other surgeon is appending modifier -59 to 22845. Does this support that? I've looked at some PEEK prostheses online, and it seems like the plate is a component of the prosthesis.

Unfortunately, the quoted portion of the op report is also the only part that pertains to the arthrodesis (the rest of the report describes my doctor's anterior approach and closure). The other office has some interesting approaches to coding, so I do need to double-check so our office is prepared for denials.

Thanks.

 

[jghaddock]

Co-Surgeon / Assistant Surgeon / Plates & Cages

I have a related question. I work for the general/vascular surgeon who performs the approach, then stays on to assist.

The other surgeon's report says "Annulectomy followed by diskectomy and decompression was performed with resection of posterior annulus and bilateral foraminotomies. This allowed for 14 mm height 11 degree lordotic PEEK prosthesis combined with bone morphogenetic protein and local bone graft. Anterior Synthes titanium instrumentation was used spanning L5 and S1. The 6.2 x 25 mm screws were utilized."

The other surgeon is appending modifier -59 to 22845. Does this support that? I've looked at some PEEK prostheses online, and it seems like the plate is a component of the prosthesis.

Unfortunately, the quoted portion of the op report is also the only part that pertains to the arthrodesis (the rest of the report describes my doctor's anterior approach and closure). The other office has some interesting approaches to coding, so I do need to double-check so our office is prepared for denials.

Thanks.

To answer your main question - that op note sounds like a separate PEEK cage / prosthesis and plate to me. For Medicare (and probably others to follow), the modifier 59 on the +22845 is appropriate. Any time I've had a surgeon use a cage with the "integral anterior instrumentation" the surgeon uses the word "tabs". He/she will insert the cage, then insert a tab in the cage which helps stabilize it. The surgeon I work for now never uses "integral anterior instrumentation".

On another note...

Your surgeon is doing the approach and would not be able to bill either add-on code 22845 or 22853 as a co-surgeon with modifier 62. My AMA CPT book states "Do not append modifier 62 to spinal instrumentation codes 22840-22848, 22850, 22852, 22853, 22854, 22859." As the spine surgeon coder, I get with the exposure surgeon on these anterior interbody lumbar fusions (ALIF) and let them know which codes they can bill. I've been in situations where the co-surgeon bills the ALIF code 22558-62, then bills the instrumentation codes as an assistant with modifier 80. It helps if the spine surgeon will list that surgeon as the co-surgeon for approach and closure, then assistant on the rest. I don't know if they ever get paid on that stuff.