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Posterior Lumbar Interbody Fusion

  1. #1
    Location
    Honolulu
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    20
    Default Posterior Lumbar Interbody Fusion
    Medical Coding Books
    1. If a posterior lumbar interbody fusion including discectomy was performed (22630) at L4-5, can the surgeon also submit a claim for a laminectomy at the same L4-5 level (i.e., 63047 for the L4 segment and +63048 for the L5 segment)?
    2. If a posterior lumbar interbody fusion including discectomy was performed (22630) at L4-5 level, can the surgeon also submit a claim for an anterior discectomy (22224) at either the L4 or the L5 segment?

  2. #2
    Default
    63047-48 If the surgeon performs & documents all 3 Laminectomy, facetectomy, AND Foraminotomy.

    There is no CPT code for "anterior" discectomy needs unlisted, if discectomy was performed for decompression and not simply as preparation for the Fusion.
    Yoli
    Last edited by Yoli; 02-04-2010 at 03:52 PM. Reason: sorry meant to enter & instead of 7

  3. #3
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    I disagree w Yoli......the posterior interbody fusion (22630) is the only code you can use because they are the same levels. (anatomical sites)

    I would say yes to billing the second anterior with a 59 modifier, because they would have to turn patient over and make a new incision.....but review your operative note for such.
    jdemar, CPC, CMA

  4. #4
    Default
    In the 22630 the laminiectomy is mentioned as included and it has to do with "preparation" of the fusion. But if the laminectomy is performed for other than the preparation, it is reportable. Documentation must state the lami is for decompression. 63___codes.
    Yoli

  5. #5
    Location
    North Carolina
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    3,126
    Default
    Quote Originally Posted by Yoli View Post
    In the 22630 the laminiectomy is mentioned as included and it has to do with "preparation" of the fusion. But if the laminectomy is performed for other than the preparation, it is reportable. Documentation must state the lami is for decompression. 63___codes.
    Yoli
    I agree...If you have supportive documentation....

    The CPT Assistant (January 2001, Vol. 11, No. 1) states: “For both codes 22554 and 22630, if the surgeon is removing disk and/or bony endplate solely with the need to prepare the vertebrae for fusion, then no additional 63000 series code(s) is reported. The appropriate 63045-63048, 63075-63078 code(s) should be reported, when in addition to removing the disk and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root(s), which requires work in excess of that normally performed when doing a posterior lumbar interbody fusion (PLIF).”

    This is also in compliance with the AANS...

  6. #6
    Location
    Greater Pittsburgh
    Posts
    390
    Default
    I agree, sorry I misunderstood the question.
    jdemar, CPC, CMA

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