Intervertebral Device 22853

Question:

I code for a neurosurgeon and he insists that I bill the cage code, 22853, for each interspace.  However, the CPT book lists as cage(s) therefore our thinking is that no matter how many are placed this code is only allowed one time per surgery.  His note states “C3-C4, C4-C5, C5-C6 anterior cervical interbody fusion using PEEK interbody spacers.”  So is it 22853 x 1 unit or 22853 x 3 units?

Answer:

Your neurosurgeon is correct. CPT code 22853 is reported per interspace to describe intervertebral biomechanical devices, including PEEK cages. The term is both single or plural, “cage(s)”, because sometimes there are two devices placed at a single spinal level.

*This response is based on the best information available as of 05/25/17.

Corpectomy Denial

Question:

We submitted an op note at the request of a payer (not Medicare) and they denied the corpectomy code we billed, 63081 with the fusion code, saying the documentation doesn’t support it.  Instead, they paid us for 22551. I don’t understand this because my neurosurgeon’s operative note says he did a corpectomy.

Answer:

Ah, but does the operative note specifically state he removed at least 50% of the cervical vertebral body – or that he did a total corpectomy – to justify using a corpectomy code. I suspect not which is why the payer “downcoded” 63081 and the fusion code to the anterior cervical decompression/discectomy and fusion code, 22551.

CPT guidelines specifically state that at least 50% of the cervical vertebral body must be removed to support using a corpectomy code. Recently, Cigna released guidance that says: “A targeted subset of cervical vertebral corpectomy claims billed with CPT codes 63081 and 63082, and where abuse is probable, will be pended. The operative report will then be reviewed before reimbursement to determine if the corpectomy criterion is met. If it is not met, the claim will be denied.”

The point is that the percentage of the vertebral body removed must be documented in the operative note to justify reporting a corpectomy code.

*This response is based on the best information available as of 04/27/17.

Exploration of Fusion (22830) – Two Questions Answered

Question:

Can we bill 22830 with modifier 50 because we explored both sides?

Question:

Can we bill 22830 for each level explored?

Answer:

No and no. CPT 22830, for exploration of spinal fusion, is used once regardless of the number of levels explored. It is assumed that you explore “both sides” of the spine which is typically considered a central structure from a coding standpoint.

*This response is based on the best information available as of 04/13/17.

Endoscopic Transnasal Pituitary Tumor Removal

Question:

I’m confused.  Should I use 61548 vs 61580 & 61600 to bill an endoscopic transnasal approach to remove a pituitary tumor?  Or is this an unlisted code (64999)?

Answer:

Good question – there are actually 3 CPT codes that specifically address removal of a pituitary tumor none of which are the skull base surgery codes you asked about (61580 & 61600).  They are listed in the table below:

CPT Code	CPT Descriptor	Approach
61546	Craniotomy for hypophysectomy or excision of pituitary tumor, intracranial approach	Craniotomy, open
61548	Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic	Transnasal or transseptal using a microscope
62165	Neuroendoscopy, intracranial; with excision of pituitary tumor, transnasal or trans-sphenoidal approach	Transnasal or trans-sphenoidal using an endoscope

The codes, 61580 and 61600, are skull base codes which require an open approach and are not used to report transnasal procedures.

So there is a code for the procedure you describe and that is 62165.  Remember to append modifier 62 (two surgeons) if the approach is performed by the otolaryngologist (both surgeons report 62165-62).

*This response is based on the best information available as of 03/30/17.

Denials of 20930 and 20936

Question:

I’m new to neurosurgery coding and notice a big problem with denials. Medicare doesn’t pay us on 20930 and 20936. I’ve been appealing but don’t seem to have any success. Can you help?

Answer:

While CPT says it is accurate to code 20930 (morselized allograft) and 20936 (local autograft), Medicare considers both codes “bundled” into the primary code which is typically an arthrodesis/fusion code. Accept these denials and don’t waste your time appealing denials to Medicare.

*This response is based on the best information available as of 03/16/17.

New Spinal Cage Codes – 2017

Question:

I see that CPT code +22851, Application of intervertebral biomechanical device(s) to vertebral defect or interspace was deleted effective 1/1/17. What code do I now use?

Answer:

Three codes have been added to CPT 2017 to replace +22851:

• +22853 is used for a device, with fusion, with or without integrated anterior fixation
• +22854 is used for a device to fill a corpectomy defect, with fusion, with or without integrated anterior fixation
• +22859 is used for interbody device insertion without fusion

Note that +22853 and +22854 include the integral anterior instrumentation for device anchoring when that type of device is used. If you do not use integrated fixation, it is still the same codes, +22853 or +22854. If you use a separate plate, you may separately report a code such as +22845 when the plate meets the code criteria (e.g., the plate crosses the interspace, can provide independent stabilization, and can be used with any other type of interspace device).

*This response is based on the best information available as of 01/05/17.