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Spinal Surgery Coding

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    Medical Coding Books
    The only thing I would question is billing 20926 twice from what I see, the code is for grafts it is general in nature and may be taken from multiple sites. This code I would bill with a 51 modifier. It is not 51 exempt.

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    Again, a 59 modifier is not being stuck on anything to get it out the door, it depends on what your specific carrier wants. BCBS in Pennsylvania wants units, some specific workers comp carriers want line by line with a 59 on the additional unit code, for example 22614, 22614 59. A 59 on a code does not warrant 100% of allowable payment if billed on 2 primary procedure codes such as 22630 and 63047 59. (You would get 50% of the allowable for 63047). 59 is just being used to indicate that the secondary procedure is being done at a different site, body area or for a different disease or condition. If I would bill 22614 and 22614 59, I would expect 100% of the allowable for both codes as they are both modifier 51 exempt procedures. For more clarification on this issue, and other spinal coding issues, I would suggest attending the American Association of Neurological Surgeons Reimbursement and Coding Challenges educational seminar. Again, in the AANS seminar we are told for 51 exempt codes to either bill as 22614 x 2 or 22614 and 22614 59 depending on your insurance carrier. The presenters at this seminar have a lot of coding experience and some sit on the CPT Assistant Editorial Panel and serve as liasons to the AANS/CNS Coding and Reimbursement Committee so I highly doubt that they would give incorrect advice. Again, I would check with your individual insurance carriers as to how they want additional units billed. Billing as units or billing per line item with a 59 on the second duplicate code is not incorrect coding.

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    One additional thing I am curious about though is using 20926 for spine cases, usually, we uste this code for graft used with crani codes such as Removal of pituitary tumour, 61548. Is your physician using bone graft obtained from the same incision (ribs, spinous prcess or laminar fragments)? Local bone graft would be 20936 and would only be billed once. If he is using morcellized bone graft obtained through the hip, it would be 20937. I would review to see if you are maybe using the incorrect graft code. Any additional questions or if you would like to send me more detail about the graft, please email me at

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