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deickbush

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I need some help with coding for a TLIF procedure. The Procedures are:
1. Removal of segmental spinal instrumentation
2. Exploration of previous spinal fusion with identification of pseudoarthrosis.
3. Insertion of segmental spinal instrumentation (L1, L2, L3 and L4).
4. Use of intraoperative fluoroscopy for placing pedicle screws.
5. Decompression bilateral facetectomies and farminotomies (L1-L2).
6. Transforaminal lumbar interbody fusion at L1-L2.
7. Insertion of PEEK cage L1-L2.
8. Posterolateral spinal fusion L1-L4.
9. Use of local bone, bone morphogenic protein, and demineralized bone matrix for anteroposterior spinal fusion.

My confusion is with the new codes of 22633/22644. Do the new codes replace 22612/22630, so we should bill 22633 and 22634 (x2), or do we bill 22633 and 22614 x 2, or none of the above :confused:

In addition, the surgeon feels he should be able to bill 63056. I have gotten conflicting information on this, so if anyone has anything in writing to support or not support, I would really appreciate it !!
 
Yes the new codes 22633/ 22634 does replace 22612/ 22630. In other words you can not bill out 22612 and the 22630 together UNLESS done on separate levels of the spine. If perform on the same level use 22633/22634. So you would code

22633
22634 x 2
22842
22851
20936
20930

If the your doctor is wanting to use code 63056 for
HTML: 
[B]decompression[/B]
I think you can use it with modifier -59. Is that why he is wanting to use it for decompression? I'm not 100% sure on that maybe someone can reply about that. But I know before we were allowed to use 63030 or 63047 for decompression with modifier -59 with the old TLIF codes. I don't know about 63056.

You can't bill for the removal of instrumentation because the doctor is putting in a new one. You only bill for the insertion.

And I'm not sure about billing for the fluoroscopy it might be inclusive to the procedure but again I'm not 100% sure on that either.

Does anyone else have any other suggestions?????
 
You can bill the flouroscopy (76000-59-26) and medicare pays it and the commercial insurances are hit or miss some pay some don't. Hope this helps
 
I would not bill the fluoroscopy. There is an edit that says you are not supposed to bill this separately. The reason Medicare may be paying is because it is being billed with a 59 which is inappropriately undbundling the code. Also my notes from a coding class with AANS state that fluoroscopy is inclusive.
 
I would bill 22633 and 22614 x 2. It does not look like an interbody fusion was done in addition to the posterolateral fusion at L2-L4 so you cant bill 22634 x 2. You can bill for the lami with a 59 modifier if done for purposes of decompression. He doesnt say he did a far lateral discectomy so if he did the lami for stenosis and for purposes of decompression and specifies nerve roots decompressed, you would bill 63047 59 and 63048. If he doesnt specify nerve roots decompressed, bill 63047 59. Far lateral discectomy can not be billed.
 
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