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ACDF at C3-4 and C6-7

  1. Default ACDF at C3-4 and C6-7
    Medical Coding Books
    This procedure was performed through 2 different incisions first at C3-4 and then at C6-7. Would you code 22554 for each level or use additional level codes??


  2. #2
    Procedure codes 22554-22558 are for SINGLE interspace, for additional interspaces, use 22585 the add-on code. Hope this helps!

  3. Default
    But what about the two separate incisions??


  4. #4
    Seattle First Hill
    Since the doctor is skipping from C3-4 to C6-7, it is appropriate in this case to code both levels with a 22554. Make sure you add a -59 on the second line as well.

  5. #5
    North Carolina

    Since this was a separate incision and the fusion is not subsequent I would report 22554 -59 for the additional fusion site. This follows the guidelines for modifier 59 since it is a separate incision and also follows CPT Assistant from November 2007 regarding procedures that are not subsequent. Although the question pertains to instrumentation, the same concept applies.

    Question: What is the appropriate code to report if anterior instrumentation is inserted at vertebral segments C3-4 and additional instrumentation is inserted at C6-7, but vertebral segments C4-5 and C5-6 are not fused? Are the anterior instrumentation codes assigned strictly by the TOTAL number of spinal segments with instrumentation applied (ie, 22846) or is the appropriate code chosen based on the vertebral segments involved in each separate construct (ie, 22845, 22845 59)?

    Answer: Anterior instrumentation codes 22845-22847 may be reported separately with modifier 59, Distinct procedural service, appended when the procedure involves the work of putting two separate plates in the spine at different locations. Therefore, in this clinical scenario, it would be appropriate to report CPT code 22845, Anterior instrumentation; 2-3 vertebral segments, for C3-4 and CPT code 22845 with modifier 59 for C6-7.

  6. Default
    I have been having a real problem getting specific claims paid with Medicare. I have coded 22845 & 22845-59 on 2 separate OP notes. MCR has denied them due to MUE guidelines. I have sent out a 1st and 2nd level appeal was well as an appeal to an independent contractor. They all say that Medicare will only pay for 1 unit of 22845 per day. Whenever a fusion is done at C3-4, skip C4-5 and fuse at C5-6 & C6-7, is it appropriate at report 22846? I don't think it is because of the details underneath the SPINAL INSTRUMENTATION guidelines on page 118 in the CPT book. Any ideas? I hate to just write this off. Any help would be greatly appreciated.

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