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Thread: Anterior cervical discectomy and fusion C4-C5, C5-C6, C6-C7

  1. #1

    Default Anterior cervical discectomy and fusion C4-C5, C5-C6, C6-C7

    Please help. Spine surgery is really getting the best of me. How would you code this?
    Pre-op dx: 1.Cervical degenerative disk disease. 2. Cervical stenosis 3. Cervical spondylosis 4. Cervical radiculopathy
    Post-op dx: same as above
    Procedure performed:
    1. Anterior cervical discectomy and fusion C4-C5, C5-C6, C6-C7
    2. Partial corpectomy C5
    3. Partial corpectomy, C6
    4. Partial corpectomy, C7
    Procedure A left-sided incision was made and Smith Robinson approach was utilized to dissect down to the ventral aspect of the cervical spine. We localized the levels radiographically and elevated the longus collo from the mid body of C4 to the mid body of C7. We then placed shadow line retractors over the C4-C5 disc space and performed a discectomy in standard fashion and the discectomy was carried down to the level of the posterior longitudinal ligament. We retrieved one fragment of disc from the midline where ther was a disruption of the posterior longitudinal ligament. otherwise, there was minimal canal or foraminal disease at this level. We then placed a size 7 cortical cancellous spacer and moved the Caspar pins over the C5-C6 diisc space where ventral osteophytes were resected as well as posterior osteophyte and foraminal osteophyte affecting a subtotal corpectomy throughout the course of the discectomy. Bilateral anterior foraminotomies were performed and the posterior longitudinal ligament was taken down bilaterally, centrally was left intact. we placed a size 8 cortical cancellous spacer, moved the Caspar pins to the C6-C7 disc space and in a similar fashion during our diskectomy, resected the ventral posterior foraminal osteophyte affecting a subtotal corpectomy of C6 and C7 to obtain complete decompression. We then placed a size 8 cortial cancellous spacer and removed the Caspar pins in the shadow line rectors. An anterior cervical plate by Medtronic was placed on the ventral aspect of the cervical spine and intraoperative AP and lateral radiographs were obtained, which confirmed postiton of all implants and grafts. we ensured absolute hemostasis, a deep drain was placed. the wound was closed in layers. The patient awoke without event and was taken to the recovery room in stable condition.

    CPT codes used; 63081, 63082 x2, 22551, 22552 x2, 22846, 22851x2, 20931, and 20936.
    I do not feel these are all correct. Please give me your opinion and also Thanks for all your help.

  2. #2

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    I wouldnt code a corpectomy. You have to document that 1/2 of the vertebral body was removed for cervical, 1/3 for lumbar and thoracic. The word subtotal isnt enough, the dr. has to state what portion was removed. If not, it is a discectomy which would be 22551 and 22552 x 2. I dont see, unless I am missing it where local bone was used so I wouldnt use 20936. the spacer would be 20931. The plate would be 22846, although I would let the dr. know that he really should dictate at which levels he places the instrumentation. Hope this helps!

  3. #3

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    i would say that those codes are correct but you 22851 needs to be times 3 because it is a 3 level fusion. & if bone marrow aspirate was used you need the 38220X2. I work for a spine surgeon & use these codes all day long. We very rarley do the ACDF with corpectomy. I do know that the operative report needs to very clearly detail the corpectomy along with the ACDF or they will bundle into one another. Hope this helps.

  4. #4

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    I work with neurosurgeons as well and we do perform a lot of ACDF's, quite a few are with corpectomies. You can not bill for a discectomy 1 level above, below or at the same segment that you do a corpectomy, it is included. If you bill 22551 with 63081, this is like billing 63075, 22554 and 63081 together for the same level, the discectomy is included and will get thrown out anyway. If you bill for a corpectomy, you would bill 63081 and 22554 plus the additional level codes. If you give me your fax number, I would be happy to fax you an instrumentation "cheat sheet" that I use all the time which gives the name of a type of graft and what code to bill which we obtained at a coding seminar. Thank you.

  5. #5

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    OMG, Thank You so much, I really struggle with spinal procedures My fax # is 352-567-6439. I really appreciate this, send me everything you have.

  6. #6

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    No problem! I will send right away. Thank you, I will just put to attn: N E Smith.

  7. #7

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    can you fax this cheat sheet to me at (512) 524-2251, attention Donni.

    I would really appreciate this. Thanks, Donni

  8. #8
    Join Date
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    Default

    Quote Originally Posted by penguins11 View Post
    I work with neurosurgeons as well and we do perform a lot of ACDF's, quite a few are with corpectomies. You can not bill for a discectomy 1 level above, below or at the same segment that you do a corpectomy, it is included. If you bill 22551 with 63081, this is like billing 63075, 22554 and 63081 together for the same level, the discectomy is included and will get thrown out anyway. If you bill for a corpectomy, you would bill 63081 and 22554 plus the additional level codes. If you give me your fax number, I would be happy to fax you an instrumentation "cheat sheet" that I use all the time which gives the name of a type of graft and what code to bill which we obtained at a coding seminar. Thank you.

    Would you mind faxing to me also? I'm trying to get more confident in coding neurosurgery, and would like any resources possible!! My fax is 225-768-2806. TIA!!!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  9. #9

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    I am faxing the info requested today to both Donni and Meagan. Hope it helps.

    Thanks!

  10. #10

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    Quote Originally Posted by NESmith View Post
    Please help. Spine surgery is really getting the best of me. How would you code this?
    Pre-op dx: 1.Cervical degenerative disk disease. 2. Cervical stenosis 3. Cervical spondylosis 4. Cervical radiculopathy
    Post-op dx: same as above
    Procedure performed:
    1. Anterior cervical discectomy and fusion C4-C5, C5-C6, C6-C7
    2. Partial corpectomy C5
    3. Partial corpectomy, C6
    4. Partial corpectomy, C7
    Procedure A left-sided incision was made and Smith Robinson approach was utilized to dissect down to the ventral aspect of the cervical spine. We localized the levels radiographically and elevated the longus collo from the mid body of C4 to the mid body of C7. We then placed shadow line retractors over the C4-C5 disc space and performed a discectomy in standard fashion and the discectomy was carried down to the level of the posterior longitudinal ligament. We retrieved one fragment of disc from the midline where ther was a disruption of the posterior longitudinal ligament. otherwise, there was minimal canal or foraminal disease at this level. We then placed a size 7 cortical cancellous spacer and moved the Caspar pins over the C5-C6 diisc space where ventral osteophytes were resected as well as posterior osteophyte and foraminal osteophyte affecting a subtotal corpectomy throughout the course of the discectomy. Bilateral anterior foraminotomies were performed and the posterior longitudinal ligament was taken down bilaterally, centrally was left intact. we placed a size 8 cortical cancellous spacer, moved the Caspar pins to the C6-C7 disc space and in a similar fashion during our diskectomy, resected the ventral posterior foraminal osteophyte affecting a subtotal corpectomy of C6 and C7 to obtain complete decompression. We then placed a size 8 cortial cancellous spacer and removed the Caspar pins in the shadow line rectors. An anterior cervical plate by Medtronic was placed on the ventral aspect of the cervical spine and intraoperative AP and lateral radiographs were obtained, which confirmed postiton of all implants and grafts. we ensured absolute hemostasis, a deep drain was placed. the wound was closed in layers. The patient awoke without event and was taken to the recovery room in stable condition.

    CPT codes used; 63081, 63082 x2, 22551, 22552 x2, 22846, 22851x2, 20931, and 20936.
    I do not feel these are all correct. Please give me your opinion and also Thanks for all your help.
    Here is some additional information regarding what documentation needs to support for the reporting of 63081:

    NASS just printed in the 2011 Common Coding Scenarios the following on page 97: "Vertebral corpectomy is not used for resection of osteophytes. It is recommended that at least half of the vertebral body be removed when reporting this code. A corpectomy includes both the cranial and caudal discs and anterior discectomy is not separately reportable at the same segment."


    Here is the information from the AMA and they give several sources in their reply and I noticed one is from 2008 so the above from NASS of 2011 might be helpful also:

    "Question #3: Can they also bill for a corpectomy at C4/5 when also doing an arthrodesis and discectomy and that same level - 22551 and 63081?

    AMA Response. Depends. According to the American Association of Neurological Surgeons definition of “corpectomy”, the amount of bone removed will still usually exceed one third of the mass of the vertebral body, and sometimes comprise the majority of the body.

    As defined in the Anterior o Anterolateral Approach Technique CPT guidelines, page 104 of the professional edition of CPT® 2011, “A vertebral interspace is the non-bony compartment between two adjacent vertebral bodies, which contains the intervertebral disc, and includes the nucleus pulposus, annulus fibrosus, and two cartilagenous endplates”. The CPT spine “arthrodesis” codes include preparation of the vertebral body endplates. If the amount of bone to prepare the interspace for fusion does not exceed “one-third of the mass of the vertebral body”, then it is not appropriate to additionally report code 63081, Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment.

    As stated below, to qualify for reporting a vertebral corpectomy code, “The bone removal includes at least one intervertebral endplate, and may extend to the other unless terminated within the body to secure the end of a strut graft. The amount of bone removal is generally at least one-half of the body, and is significantly greater than the removal of cortical endplates for an interbody arthrodesis (eg, 22554).”

    The following definition of vertebral corpectomy is provided in the American Association of Neurological Surgeons, 2008 coding guide for CPT code 63081, Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single segment:

    “Vertebral corpectomy: Partial or complete, is used to describe removal of a substantial portion of the body of the vertebra. In the cervical spine, this generally includes removal of a longitudinal portion of the vertebral body to the spinal canal, and may include the posterior longitudinal ligament. The bone removal includes at least one intervertebral endplate, and may extend to the other unless terminated within the body to secure the end of a strut graft. The amount of bone removal is generally at least one-half of the body, and is significantly greater than the removal of cortical endplates for an interbody arthrodesis (eg, 22554). In the thoracic and lumbar spine, the location of bone removed will usually be either lateral or anterolateral due to the restrictions of various approaches to the spine. However, the amount of bone removed will still usually exceed one third of the mass of the vertebral body, and sometimes comprise the majority of the body."

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