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Is code 22612 bundled into 22630?

  1. #1
    Default Is code 22612 bundled into 22630?
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    Hello,
    My clients do procedures 22612 and 22630 when they do lumbar spine fusions.
    When I bill these 2 codes, insurance cos bundle 22612 into 22630.
    They pay on code 22630 and deny code 22612???
    Why are these 2 codes bundled? My doctors tell me that these are separate procedures and should not be bundled???
    thx
    ken

  2. Default
    I checked the CCI Edits 17.2 and it indicates "No bundling issues exist".

    Per NASS (North American Spine Society) :

    "There is nothing that precludes a physician from performing both a posterior arthrodesis and an interbody fusion at the same level. These represent different areas of spinal fusion. Interbody should include documentation of discectomy, decortification of endplates, removal of cartilage and placement of bone/cages, whereas posterolateral should include documentation of decortification of facets and transverses processes and placement of bone posterolaterally on these areas. The real work is not laying bone in the posterolateral gutters but the exposure and decortification."

    "http://www2.aaos.org/aaos/archives/bulletin/aug04/code.htm

    "Arthrodesis—The sixth edition of A Manual of Orthopedic Terminology defines spinal arthrodesis as: “A procedure to remove the cartilage of any joint to encourage bones of that joint to fuse, or grow together, where motion is not desired.” Confusion in selecting arthrodesis codes results from the use of CPT terms ‘interspace' and ‘vertebral segment.' Both terms are used in the arthrodesis section (22XXX series). For example, code 22630, for posterior lumbar interbody fusion (PLIF or TLIF) is defined as “Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar,” which is normally done just in the lumbar spine area because the spinal cord is in the way in other locations. This description uses the term ‘interspace.' However, code 22612 describes “Arthrodesis, posterior or posterolateral technique, single level; lumbar” and code 22614 states for “each additional vertebral segment.” This seems to be giving conflicting information as to how to appropriately code for multiple level arthrodesis. Fusing a single level technically includes two vertebrae and the intercalary disc. A single vertebra cannot be fused to itself, and adding another vertebra to the fusion requires the crossing of an interspace. Whether the procedure is performed anteriorly or posteriorly, and whether the code description states segment, level or interspace, once the fusion is extended, an interspace and another vertebra must be added. "

  3. #3
    Location
    Long Island/New York
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    1,271
    Default
    Quote Originally Posted by klobo View Post
    Hello,
    My clients do procedures 22612 and 22630 when they do lumbar spine fusions.
    When I bill these 2 codes, insurance cos bundle 22612 into 22630.
    They pay on code 22630 and deny code 22612???
    Why are these 2 codes bundled? My doctors tell me that these are separate procedures and should not be bundled???
    thx
    ken
    They can be paid now but come 2012 they will be combined together...

  4. #4
    Location
    North Carolina
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    3,126
    Default
    Quote Originally Posted by nyyankees View Post
    They can be paid now but come 2012 they will be combined together...
    Can you provide the source for this information?

    TIA~

  5. #5
    Location
    Long Island/New York
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    Quote Originally Posted by RebeccaWoodward* View Post
    Can you provide the source for this information?

    TIA~
    It will be released in Novemeber by NASS. I am directing my spine docs as a "it's coming but I won't have official documentation until Novemeber"...They want to know a.s.a.p.

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Thumbs up
    Thanks! I'll be on the lookout.

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