Wiki Osteotomies 22212 22214

[melanied]

Hello
I have a debate on these codes and the dx codes that we can bill with them. AANS tells us that we can only bill the 22212 and 22214 etc. with deformity codes correct? I have sent a case to be audited and heve been told that I can bill the SPO codes withdx of M47.816 and M47.817 ( Spondylosis w/o myleopathy) I am posting this as I hope that we have not been leaving monies on the table as we were told only deformity codes were to be used. Are we correct as we can only bill for the deformity with SPO CPT codes? Thank you

 

[amyjph]

Where does the AANS say that? Just looking for the reference, I'm sure that's what it says. That's what these codes are for.

I think I would have to see the op report to see what else was done with it and the diagnoses. There are usually multiple diagnoses on these type cases. Does the op note say for correction of deformity? I remember seeing those words used a lot in the description of the procedure in the body when coding that code group (2221_ area).
The guideline in the CPT section for these codes under the osteotomy heading states, "Spinal osteotomy procedures are reported when a portion(s) of the vertebral segment(s) is cut and removed in preparation for re-aligning the spine as part of a spinal deformity correction. I don't think I would just omit the CPT code unless there was some reason such as edits preventing unbundling or some other reason.

These procedures aren't done if they are not correcting a deformity, fixing alignment, restoring sagittal balance. They aren't just randomly going to do an osteotomy if that is not the intent. Usually you would see kyphosis, lordosis, scoliosis, flatback syndrome, ankylosis spondy, etc. For adults it's usually scoliosis.

Most payers have policies and guidelines on these. Example: https://www.aetna.com/cpb/medical/data/700_799/0743.html