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2012 Lumbar Fusion Help

  1. Default 2012 Lumbar Fusion Help
    Medical Coding Books
    I just finished a webinar on the updates/changes for 2012.
    In the webinar, they said that the codes for a posterior lumbar fusion, 22612 and 22630, were now being merged. The new code is 22633. However, the code for intervertebral cages (22851), and the codes for pedicle fixation (22840, 22842, etc.) are not eligible to be used with this new code. That is, according to the new 2012 CPT manual in the individual code descriptions.
    In light of this, what code(s) shall we use when our doc does a TLIF or PLIF
    after January 1, 2012?
    I feel that this must be an oversight. Whom can we report this to?


  2. Default Agreed!
    I just got my first denial from Medicare regarding the instrumentation codes! I think CPT made a big error and either needs to create additional CPT codes for 22633 or link these new fusion codes to the existing codes we have always used. I am thinking I will appeal this with maybe an unlisted code until they get this fixed!

  3. Default
    This is a mistake and the AANS is working on this with the AMA to include in their 2012 CPT Errata document. Check the link periodically below to see when this is fixed and you should be able to appeal referencing this document. I would not bill an unlisted code, you cant use an unlisted code when another more appropriate code is available just to get payment.

  4. #4
    South Denver
    Default fusion and hardware
    i don't see an update yet - am i correct??? or am i not seeing something here??? - thanks!!! this is pretty horrible for us lol

  5. Default fusion hardware
    I asked our questions to the AMA - via there education and information service department and this is the response I received:

    Please be advised that at the upcoming May 2012 meeting, the CPT Editorial Panel Executive Committee and the CPT Editorial Panel will be addressing the reporting of code 22633 and its appropriate reporting in conjunction with segmental instrumentation codes.

    Any information pertaining to the use of these codes will be forthcoming subsequent to the finalization of the Minutes of the May 2012 Panel meeting.

    We appreciate your patience and will immediately contact you when we have received CPT Editorial Panel input regarding your coding question.

    Thank you for your inquiry and we hope that this information is of assistance to you.


    CPT Education and Information Services

  6. #6
    Nashville AAPC Chapter
    We are getting these scenarios paid by writing a careful appeal stating the the combination code is correct based on 2012 CPT manual, then detailing the 22612 and 22630 parenthetical instructions.

    Hope that helps until MCR gets an errata out for us.

  7. Question instrumentation
    This is the primary procedure 22630 with the add-on code 22842 and 22851 with the invoice of cage and screw. Can we bill both code 22842 and 22851 if not, i will bill 22851 is this correct?

  8. #8
    22842 and 22851 are add on codes and not bundled with any of the fusion codes.

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