Overcome Your Spinal Surgery Medical Coding Dilemmas


 

Read these spinal surgery medical coding and billing question and answers and know what codes apply to get the maximum ethical reimbursement you deserve.

Question: If they added on open or endoscopic to the 63020 in that family of code which is inclusive of the 63030, does that also include the re-exploration code 63042 and 63040?

Answer: The answer is that they intent is yes, it does include that whole family of codes. If we learn from experience based on feedback that payers are still considered or surgeons are still confused or coders are confused about that, then we'll add the editorial language to 63040 to 63044 as well.

The difficulty with CPT recently is that there's been a lot more introspection of editorial changes and whether that change is the value of the code and whether it should go to the RUC's. So there's always a hesitancy of making medical coding and billing changes to a whole series of codes before we can fill out CPT and be sure that they're only going to make an editorial change without sending it to be revalued.

So that's why it was not applied directly to 63040 to 63044. But by analogy since it's the same type of procedure but just redoing it, our advice would be that yes, the endoscopic approach is applicable to all of those.

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Question: When is it appropriate to bill the corpectomies when you do the fusion? A lot of the reports you see - they'll explain the fusion really well and then they'll say partial corpectomy with reforms.

Answer: It's a great question. And something that has come up more and more often among payers is how do you define what a partial corpectomy is. And if you think about it from the anatomical and surgical perspective, all corpectomies that are done are technically partial with the exception of certain tumors. There's usually a border of the vertebral body that's left alone in order to protect the surgeon from encountering important blood vessels like the vertebral artery in the cervical spine or the aorta in the thoracic spine or the iliac vessels in the lumbar spine.

So, in the AANS medical coding guide - and we believe in the NASS coding scenarios guide as well, there are some rough medical coding guidelines to guide coders as to how do you define a corpectomy. So in the cervical spine more than half of the vertebral body needs to be removed in order to use the corpectomy code, in the thoracolumbar spine, it's more than 1/3.

But the real principle of corpectomy is that you're decompressing over a longer segment from disc space to disc space. So what we would expect to see in an operative note is a description that a partial corpectomy for example was performed at C6 from the C56 to the C67 interspace to decompress the spinal cord. And that would tell us that a corpectomy was done.

What some surgeons are doing inadvertently is using the language incorrectly and saying, “I did a partial corpectomy” when in fact an extended discectomy was done. Keep in mind that the discectomy codes anteriorly include osteophyte removal as well as some bony removal that's required in order to decompress the nerve roots or the spinal cord at the interspace level. So you really should be going disc space to disc space in order to be able to use the corpectomy code.

 

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