Coding for Spine Procedures that Cross Spinal Junctions

Question:

How do you report a spinal procedure for example, arthrodesis or laminectomies when two spinal are involved. For example., both thoracic and lumbar spine?

Answer:

Report one stand-alone/primary code even when the procedure crosses spine junctional levels. Use the stand-alone code for the spine region where the majority of the procedure/levels is performed.

• Example:T11-S1 posterolateral arthrodesis (T11-T12, T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1)
  Use 22612 (the lumbar stand-alone code, since more level were lumbar) and +22614 x 6

*This response is based on the best information available as of 08/11/22.

Removal of Interbody Device

Question:

Can code 20680, removal of implant, be used for removal of a previously placed intervertebral device, such as a PEEK cage?

Answer:

No. There is no code for removal of an intervertebral device – this would be part of an exploration of arthrodesis or new arthrodesis, if performed. Do not use 20680 (removal of implant) for removing spine instrumentation.

*This response is based on the best information available as of 07/28/22.

Coding for Percutaneous Screws and Rod Placement

Question:

I placed posterior percutaneous screws and rods without an arthrodesis. I know I have to use an unlisted code, 22899. How should I price it?

Answer:

Good question. Let’s assume you’re doing +22842 (posterior instrumentation, 3-6 segments) which is an add-on code. Add-on codes are valued for only the intra-operative portion of the service and do not include any value for pre-op (e.g., H&P, discussion with patient), certain intra-operative work (e.g., incision, closure) or post-op work.

Recall that Medicare reduces the payment for secondary stand-alone procedure codes by 50% to account for overlapping pre- and post-op work.

Therefore, we recommend you double your fee for +22842 to achieve your fee for the unlisted code. For example, if your fee for +22842 is $100 then your fee for the unlisted code would be $200.

*This response is based on the best information available as of 07/14/22.

Re-exploration Laminectomy Billing

Question:

The patient had a re-do laminectomy for stenosis at L3-L4. Can code 63042 be used for this procedure?

Answer:
No. CPT 63042 is intended for a re-do discectomy and would be inappropriate to use for a re-do laminectomy. Rather, use 63047 for this service and modifier 22 may be appended if significant additional work is documented.

*This response is based on the best information available as of 06/16/22.

Billing Additional Pre-op Visit

Question:

Since we have to bring the patients back in for COVID testing and H&P for Joint Commission, can we bill for this visit even though it’s another pre-op visit?

Answer:
Yes, since the original surgery was canceled and is now under consideration for rescheduling due to the pandemic and needs to be seen for a COVID swab prior to surgery, which is an indication for charging a new visit (as a health status change)

*This response is based on the best information available as of 06/02/22.

Inpatient E/M Coding

Question:

I did an inpatient consultation and coded 99253 (non-Medicare). I did not need to follow the patient so I signed off. They asked me to re-consult a week later.  What is the code for a re-consult?

Answer:
There are no specific E/M codes for an inpatient re-consultation.  You’ll use the subsequent hospital care code, 9923x, since it’s the same admission for the patient.

Question:Follow up question: the patient was discharged then admitted a month later and I was consulted again. Is this a subsequent hospital care code?

Answer:
No, since it’s a new admission for the patient, you’ll use the consultation code again (9925x).

Question:Last question: when I see the patient in my office a month later, is it a new patient?

Answer:
No, it’s an established patient (9921x) because you’ve had a face-to-face visit with the patient in the previous 3 years.

*This response is based on the best information available as of 05/19/22.