Universal Clamp Spinal Fixation System

Transcription

1 Universal Clamp Spinal Fixation System 2011 Coding Guide for Physicians and Hospitals Coding for the Universal Clamp System The Universal Clamp System is a temporary implant for use in orthopedic surgery. The system is intended to provide temporary stabilization as a bone anchor during the development of solid boney fusion and aid in the repair of bone fractures. The fusion is performed from a posterior approach. It is posterior segment fusion, i.e., it does not also involve interbody fusion. The clamp is used for thoracic, lumbar and/or sacral fusion, but not cervical. Although labelled for fracture treatment and other types of spinal procedures, the clamp is currently used only for spinal fusion for severe curvature of the spine including kyphosis, scoliosis and extreme lordosis. ICD-9-CM Diagnosis Codes These codes are used for severe spinal curvature: kyphosis (acquired) (postural) kyphosis due to radiation kyphosis, postlaminectomy kyphosis, other lordosis (acquired) (postural) lordosis, postlaminectomy lordosis, other postsurgical lordosis, other scoliosis/kyphoscoliosis, idiopathic progressive infantile idiopathic scoliosis scoliosis due to radiation thoracogenic scoliosis kyphoscoliosis/scoliosis, other other curvatures of spine unspecified curvature of spine certain congenital musculoskeletal deformities of spine Note that some of these codes, while valid, may not be sufficiently specific to meet medical necessity criteria in some payers medical policies.

2 The four codes below are also used for spinal curvature. However, these codes can never be assigned as the principal diagnosis. They are only for spinal curvature due to other conditions. The other condition must always be sequenced first. For example, scoliosis due to osteitis deformans (731.0) is coded plus curvature of spine, unspecified, associated with other conditions kyphosis, associated with other conditions lordosis, associated with other conditions scoliosis, associated with other conditions ICD-9-CM for Inpatient Hospital Spinal fusion is always coded with a combination of two or three ICD9-9-CM codes. The coding below is only for a posterior T1-S1 approach. The first code is the fusion itself, identified by the spinal region and the approach. The second code shows the number of vertebrae fused. If the fusion involves harvesting autologous bone, a third code is added. There are no separate ICD-9-CM procedures codes for posterior instrumentation or use of allograft bone. > Fusion Dorsal and dorsolumbar fusion of the posterior column, posterior technique Lumbar and lumbosacral fusion of the posterior column, posterior technique Lumbar and lumbosacral fusion of the anterior column, posterior technique (Note: Codes 81.0X are for the initial fusion. Refusion uses codes 81.35, 81.37, ) > Number of Vertebrae Fused Fusion or refusion of 2-3 vertebrae Fusion or refusion of 4-8 vertebrae Fusion or refusion of 9 or more vertebrae > Harvesting Autologous Bone excision of bone for graft, other site (includes harvest from pelvic bones,

3 MS-DRGs and Payment Rates for Inpatient Hospital There is a distinct set of DRGs just for fusions performed for the various forms of spinal curvature. MS-DRG Spinal Fusion Except Cervical with Spinal Curvature/ Malignancy/Infection or 9+ Fusions with MCC Spinal Fusion Except Cervical with Spinal Curvature/Malignancy/ Infection or 9+ Fusions with CC Spinal Fusion Except Cervical with Spinal Curvature/Malignancy/ Infection or 9+ Fusions without CC/MCC 2012 Medicare National Average Payment Rate $55,271 $35,716 $28,474 CPT* Codes and Physician Payment Rates CPT fusion coding is set up somewhat differently from ICD-9-CM. In CPT, spinal fusion is shown by a combination of three codes. The coding below is only for a posterior T1-S1 approach. The first code is the fusion itself, identified by the spinal region and the approach. The second code is for the use of instrumentation. Again, only posterior instrumentation codes are shown below. The third code is for laying the bone graft, autograft or allograft. > Fusion Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments 2011 Medicare National Average Payment Rate $1,349 $2,112 $2,435 *Current Procedural Terminology 2011 American Medical Association. All Rights Reserved. FY 2012 Medicare Inpatient Prospective Payment System final rule (CMS-1518-F), Table 5. Assumes payment for a large urban hospital with wage index >1 and full update. Medicare payment = MS- DRG relative weight x (labor standardized amount +non-labor standardized amount + national capital rate.) Per CMS-1503-N2 determined by multiplying the physician fee schedule conversion factor ($ ) by the total adjusted facility RVUs. Represents national average with no geographic adjustment; individual physician reimbursement will vary.

4 > Instrumentation Posterior non-segmental instrumentation (e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) 2011 Medicare National Average Payment Rate $778 $ Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure) $780 $828 $1,000 Note: The instrumentation codes are add-ons and cannot be used alone. They must always be used with the spinal fusion codes or other related procedure codes. > Bone Graft Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 2011 Medicare National Average Payment Rate $0 $ Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure) $0 $171 $188 Note: The bone graft instrumentation codes are add-ons and cannot be used alone. They must always be used with the spinal fusion codes or other related procedure codes. *Current Procedural Terminology 2011 American Medical Association. All Rights Reserved. Per CMS-1503-N2 determined by multiplying the physician fee schedule conversion factor ($ ) by the total adjusted facility RVUs. Represents national average with no geographic adjustment; individual physician reimbursement will vary.

5 Notes/Disclaimers This Coding Reference Guide is intended to illustrate the common CPT * codes, ICD-9 CM procedure codes, and common MS-DRG, APC and ASC assignment for spine product and procedures performed in the inpatient hospital, outpatient hospital, and ambulatory surgical center settings. The bookmarks in this document include physician and hospital coding information organized by Zimmer product, followed by several spinal coding scenarios and examples. To find potential codes for Zimmer products, click on the Product Coding bookmarks. Current Procedural Terminology (CPT) is copyright 2011 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. ICD-9-CM Official Guidelines For Coding and Reporting, U.S. Department of Health and Human Services, Effective October 1, Zimmer Coding Reference Guide Disclaimer Limitation on Coverage and Payment The information in this document was obtained from third party sources and is subject to change without notice, including as a result of changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature and does not cover all situations or all payers rules or policies. The service and the product must be reasonable and necessary for the care of the patient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patients medical condition, procedures performed and the products used. This document represents no promise or guarantee by Zimmer regarding coverage or payment for products or procedures by Medicare or other payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the hospital s Medicare Part A fiscal intermediary, the physician s Medicare Part B carrier, or to appropriate payers. Zimmer specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document.

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