Spinal Coding Examples

Transcription

1 Spinal Coding Examples CPT CODING EXAMPLES This list represents coding examples for common spine procedures. The information can also be used in conjunction with the Medicare Fee Calculator on to estimate the amount of physician reimbursement expected from the performance of one or more of these procedures. LUMBAR Anterior Lumbar Interbody Fusion (ALIF) with Posterior Instrumentation, if applicable ALIF with Anterior Instrumentation, if applicable Anterior Instrumentation vertebral segments 4 7 vertebral segments 8 or more vertebral segments ALIF with INFUSE Bone Graft and LT-CAGE Lumbar Tapered Fusion Device, Single Level Application of Biomechanical Device (cages, etc.) Placement of osteopromotive material Note: Effective January 1, 2011 the code description for was revised to add placement of osteopromotive material. As a result, code should be reported for rhbmp ( INFUSE Bone graft). Spinal Coding Examples 1

2 LUMBAR (continued) ALIF and Posterolateral Fusion (Classic 360 Procedure) Posterolateral Fusion, Lumbar first level each additional segment 51 for, if applicable Posterior Lumbar Interbody Fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF) with Posterior Instrumentation Posterior Interbody Fusion, Lumbar , if applicable Note: Codes and are bundled per the NCCI edits with code CPT Assistant (January 2001, page 12) states that these codes can be reported in addition to the fusion code if performed for decompression (apply modifier -59 to the decompression code in this instance). Laminectomy, Lumbar Laminectomy without facetectomy, foraminotomy or discectomy, lumbar, except for spondylolisthesis Laminectomy with removal of abnormal facets and/or pars interarticularis with decompression, for spondylolisthesis, lumbar Laminotomy (hemilaminectomy), including partial facetectomy, foraminotomy and/or excision of herniated disc, lumbar Laminotomy (hemilaminectomy), including partial facetectomy, foraminotomy and/or excision of herniated disc, re-exploration, lumbar one or two vertebral segments more than 2 vertebral segments Gill-type procedure Laminectomy, facetectomy and foraminotomy, lumbar one interspace one interspace single vertebral segment each additional segment Spinal Coding Examples 2

3 LUMBAR (continued) PLIF/TLIF and Posterolateral Fusion (Single Incision 360 ) Combined fusion, posterolateral fusion, with posterior interbody fusion Application of Biomechanical Device (cages, etc) and segment /segment, if applicable Note: Codes and are bundled per the NCCI edits with code CPT Assistant (January 2001, page 12) states that these codes can be reported in addition to the fusion code if performed for decompression (apply modifier -59 to the decompression code in this instance). PLIF with Posterior Instrumentation, via METRx System/CD HORIZON SEXTANT System Posterior Interbody Fusion, Lumbar , if applicable Note: Codes and are bundled per the NCCI edits with code CPT Assistant (January 2001, page 12) states that these codes can be reported in addition to the fusion code if performed for decompression (apply modifier -59 to the decompression code in this instance). Direct Lateral Fusion with Anterior Instrumentation (DLIF) Anterior Instrumentation , if applicable 2 3 vertebral segments 4 7 vertebral segments 8 or more vertebral segments Spinal Coding Examples 3

4 LUMBAR (continued) Posterolateral Fusion with Posterior Instrumentation Posterolateral Fusion, Lumbar first level each additional segment Discectomy, Lumbar Posterior Discectomy, Lumbar Note: If procedure is performed bilaterally, use modifier 50. Vertebroplasty Procedure Description Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance CPT Comments cervicothoracic lumbosacral each additional level Balloon Kyphoplasty Percutaneous vertebral augmentation, including cavity creation thoracic (fracture reduction and bone biopsy included when performed) each lumbar additional segment using mechanical device (eg, kyphoplasty), 1 vertebral body, non-segmental each additional instrumentation level unilateral or bilateral cannulation, inclusive of all imaging guidance; Allograft X-STOP Use of bone (morselized) graft: Interspinous Spacer System Procedure (morselized) Description Balloon Kyphoplasty CPT Autograft (rib/lamina/spinous process, same incision) Comments Autograft Insertion of (morselized, (rib/lamina/spinous posterior separate process process, incision) distraction same incision) device 0171T Add-on first level code Autograft (including (structural, necessary (morselized, removal separate of bone incision) or ligament for insertion 0172T Add-on each additional code level Autograft and imaging (structural, guidance), separate lumbar; incision) single level Discectomy, Lumbar Procedure Discectomy, Description Lumbar CPT Modifier Comments Posterior Procedure Discectomy, Description Lumbar CPT Comments Posterior Use of bone Discectomy, graft: Lumbar Spinal Coding Examples 4

5 CERVICAL Anterior Cervical Discectomy with Interbody Fusion (ACDF) Anterior interbody fusion, with discectomy and decompression; cervical below C Anterior Instrumentation vertebral segments 4 7 vertebral segment 8 or more vertebral segments Note: Do not report or with or even if performed by different physicians. To report anterior cervical discectomy and interbody fusion at the same level during the same session, use Cervical Arthroplasty Total Disc Arthroplasty, Anterior Approach, Cervical single interspace Laminoplasty Laminoplasty Laminoplasty, Cervical two or more vertebral segments Laminoplasty, With Reconstruction Cervical two or more vertebral segments With Reconstruction Spinal Coding Examples 5

6 Medtronic Spinal and Biologics Business Worldwide Headquarters 2600 Sofamor Danek Drive Memphis, TN Pyramid Place Memphis, TN (901) (800) Customer Service: (800) For more information go to The materials and information cited here are for informational purposes only and are provided to assist in obtaining coverage and reimbursement for health care services. However, there can be no guarantee or assurances that it will not become outdated, without the notice of Medtronic, Inc., or that government or other payers may not differ with the guidance contained here. The responsibility for coding correctly lies with the healthcare provider ultimately, and we urge you to consult with your coding advisors and payers to resolve any billing questions that you may have. All products should be used according to their labeling. CPT copyright 2014 American Medical Association (AMA). All Rights Reserved. CPT is a trademark of the AMA. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use Medtronic Sofamor Danek USA, Inc. All Rights Reserved. PMD /