CERVICAL PROCEDURES PHYSICIAN CODING

Transcription

1 CERVICAL PROCEDURES PHYSICIAN CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) Anterior interbody fusion, with discectomy and decompression; cervical below C first interspace each additional interspace Anterior Instrumentation vertebral segments vertebral segment 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, Cervical two or more vertebral segments With Reconstruction Current Procedural Terminology (CPT ) copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Zimmer Coding Reference Guide Disclaimer The information in this document was obtained from third party sources and is subject to change without notice, including as a result in 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. For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at

2 CERVICAL PROCEDURES FACILITY CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) with Anterior Plate Anterior column fusion, anterior approach, cervical (C2 level or below) Discectomy Insertion of interbody spinal fusion device Fusion or refusion of 2-3 vertebrae (or) Fusion or refusion of 4-8 vertebrae Excision of bone for graft, other harvested from the iliac crest or locally Intra-operative monitoring Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code Allograft is included in the fusion code and not separately reported. Cervical Arthroplasty Cervical arthroplasty Laminoplasty Other exploration and decompression of spinal canal The information in this document was obtained from third party sources and is subject to change without notice, including as a result in 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. For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at Page 2 of 15

3 LUMBAR PROCEDURES PHYSICIAN CODING Anterior Lumbar Interbody Fusion (ALIF) with Posterior Instrumentation Anterior Interbody Fusion, Lumbar first interspace each additional interspace Application of Biomechanical Device (cages, etc.) first interspace, if applicable each additional interspace Posterior Instrumentation non-segmental instrumentation segmental; 3 6 vertebral segments segmental; 7 12 vertebral segments segmental; 13+ vertebral segments ALIF with Anterior Instrumentation Anterior Interbody Fusion, Lumbar first interspace each additional interspace Application of Biomechanical Device (cages, etc.) first interspace, if applicable each additional interspace Anterior Instrumentation vertebral segments vertebral segments or more vertebral segments Page 3 of 15

4 ALIF and Posterolateral Fusion (Classic 360 Procedure) Posterolateral Fusion, Lumbar first level each additional segment Anterior Interbody Fusion, Lumbar first interspace each additional interspace Posterior Instrumentation non-segmental instrumentation segmental; 3 6 vertebral segments segmental; 7 12 vertebral segments segmental; 13+ vertebral segments Application of Biomechanical Device (cages, etc.) for first interspace, if applicable each additional interspace Posterior Lumbar Interbody Fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF) with Posterior Instrumentation Posterior Interbody Fusion, Lumbar first interspace each additional interspace Application of Biomechanical Device (cages, etc.) first interspace, if applicable each additional interspace Posterior Instrumentation non-segmental instrumentation segmental; 3 6 vertebral segments segmental; 7 12 vertebral segments segmental; 13+ vertebral segments 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.) Page 4 of 15

5 Laminectomy, Lumbar Laminectomy without facetectomy, foraminotomy or one or two vertebral segments discectomy,lumbar, except for spondylolisthesis more than 2 vertebral segments Laminectomy with removal of abnormal facets and/or Gill-type procedure pars interarticularis with decompression, for spondylolisthesis, lumbar Laminotomy (hemilaminectomy), including partial one interspace facetectomy, foraminotomy and/or excision of herniated disc, lumbar each additional interspace Laminotomy (hemilaminectomy), including partial one interspace facetectomy, foraminotomy and/or excision of herniated disc, re-exploration, lumbar each additional interspace Laminectomy, facetectomy and foraminotomy, lumbar single vertebral segment each additional segment PLIF/TLIF and Posterolateral Fusion (Single Incision 360 ) Combined fusion, posterolateral fusion, with posterior first interspace and segment interbody fusion each additional interspace/segment Posterior Instrumentation non-segmental instrumentation segmental; 3 6 vertebral segments segmental; 7 12 vertebral segments segmental; 13+ vertebral segments Application of Biomechanical Device (cages, etc.) first interspace, if applicable each additional interspace 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). Page 5 of 15

6 Direct Lateral Fusion with Anterior Instrumentation (DLIF) Anterior Interbody Fusion, Lumbar first interspace each additional interspace Application of Biomechanical Device (cages, etc.) first interspace, if applicable each additional interspace Anterior Instrumentation vertebral segments vertebral segments or more vertebral segments Posterolateral Fusion with Posterior Instrumentation Posterolateral Fusion, Lumbar first level each additional segment Posterior Instrumentation non-segmental instrumentation segmental; 3 6 vertebral segments segmental; 7 12 vertebral segments segmental; 13+ vertebral segments Percutaneous Vertebroplasty Percutaneous vertebroplasty, one vertebral body, thoracic unilateral, or bilateral injection lumbar each additional level Note: Imaging guidance is reported separately when performed. Report code for fluoroscopic guidance or for CT guidance. Page 6 of 15

7 Percutaneous Vertebral Augmentation Percutaneous vertebral augmentation, including cavity thoracic creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty) lumbar each additional level Note: Imaging guidance is reported separately when performed. Report code for fluoroscopic guidance or for CT guidance. Discectomy, Lumbar Posterior Discectomy, Lumbar first interspace each additional interspace Note: If procedure is performed bilaterally, use modifier 50. Current Procedural Terminology (CPT ) copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Zimmer Coding Reference Guide Disclaimer The information in this document was obtained from third party sources and is subject to change without notice, including as a result in 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. For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at Page 7 of 15

8 LUMBAR PROCEDURES FACILITY CODING Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation Anterior column fusion, anterior approach, lumbar anterior interbody fusion Fusion or refusion of 2-3 vertebrae (or) Fusion or refusion of 4-8 vertebrae (or) Fusion or refusion of 9 or more vertebrae Discectomy Insertion of interbody spinal fusion device Excision of bone for graft, other harvested from the iliac crest or locally Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code Allograft is included in the fusion code and not separately reported. Posterior Lumbar Interbody Fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF) with Posterior Instrumentation Anterior column fusion, posterior approach, lumbar posterior interbody fusion Fusion or refusion of 2-3 vertebrae (or) Fusion or refusion of 4-8 vertebrae (or) Fusion or refusion of 9 or more vertebrae Discectomy Insertion of interbody spinal fusion device Excision of bone for graft, other harvested from the iliac crest or locally Intra-operative monitoring Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code Allograft is included in the fusion code and not separately reported. Posterolateral Fusion with Posterior Instrumentation Posterior column fusion, posterior approach, lumbar posterolateral fusion Fusion or refusion of 2-3 vertebrae (or) Fusion or refusion of 4-8 vertebrae (or) Fusion or refusion of 9 or more vertebrae Excision of bone for graft, other harvested from the iliac crest or locally Intra-operative monitoring Note: Instrumentation is included in the fusion code and not reported separately. Page 8 of 15

9 ALIF and Posterolateral Fusion with Instrumentation (Classic 360 Procedure) Anterior column fusion, anterior approach, lumbar anterior interbody fusion Posterior column fusion, posterior approach, lumbar posterolateral fusion Fusion or refusion of 2-3 vertebrae (or) Fusion or refusion of 4-8 vertebrae (or) Fusion or refusion of 9 or more vertebrae Discectomy Insertion of interbody spinal fusion device Excision of bone for graft, other harvested from the iliac crest or locally Intra-operative monitoring Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code Allograft is included in the fusion code and not separately reported. PLIF/TLIF and Posterolateral Fusion with Posterior Instrumentation (Single Incision 360 ) Anterior column fusion, posterior approach, lumbar posterior interbody fusion Posterior column fusion, posterior approach, lumbar posterolateral fusion Fusion or refusion of 2-3 vertebrae (or) Fusion or refusion of 4-8 vertebrae (or) Fusion or refusion of 9 or more vertebrae Discectomy Insertion of interbody spinal fusion device Excision of bone for graft, other harvested from the iliac crest or locally Intra-operative monitoring Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code Allograft is included in the fusion code and not separately reported. Direct Lateral Interbody Fusion (DLIF) Anterior column fusion, anterior approach, lumbar anterior interbody fusion Fusion or refusion of 2-3 vertebrae (or) Fusion or refusion of 4-8 vertebrae (or) Fusion or refusion of 9 or more vertebrae Discectomy Insertion of interbody spinal fusion device Excision of bone for graft, other harvested from the iliac crest or locally Intra-operative monitoring Note: If structural allograft is used, do not report code Allograft is included in the fusion code and not separately reported. Page 9 of 15

10 Laminectomy Other exploration and decompression of spinal canal Percutaneous Vertebroplasty Percutaneous verebroplasty Percutaneous Vertebral Augmentation Percutaneous vertebral augmentation Discectomy Discectomy The information in this document was obtained from third party sources and is subject to change without notice, including as a result in 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. For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at Page 10 of 15

11 2012 SPINAL DRGS WITH SPECIFIC DETAIL MS-DRG 453 Combined Anterior/Posterior Spinal Fusion with MCC MS-DRG 454 Combined Anterior/Posterior Spinal Fusion with CC MS-DRG 455 Combined Anterior/Posterior Spinal Fusion without CC/MCC Spinal Fusions One or more of the following procedures: Fusion, anterior column, other cervical, anterior technique Fusion, anterior column, dorsal/dorsolumbar, anterior technique Fusion, anterior column, lumbar/lumbosacral, anterior technique AND One or more of the following procedures: Fusion, posterior column, other cervical, posterior technique Fusion, posterior column, dorsal/dorsolumbar, posterior technique Fusion, posterior column, lumbar/lumbosacral, posterior technique Fusion, anterior column, lumbar/lumbosacral, posterior technique Spinal Refusions One or more of the following procedures: Refusion, anterior column, other cervical, anterior technique Refusion, anterior column, dorsal/dorsolumbar, anterior technique Refusion, anterior column, lumbar/lumbosacral, anterior technique AND One or more of the following procedures: Refusion, posterior column, other cervical, posterior technique Refusion, posterior column, dorsal/dorsolumbar, posterior technique Refusion, posterior column, lumbar/lumbosacral, posterior technique Refusion, anterior column, lumbar/lumbosacral, posterior technique Page 11 of 15

12 MS-DRG 456 Spinal Fusions Except Cervical with Spinal Curvature, Malignancy or 9+ Fusions with MCC MS-DRG 457 Spinal Fusions Except Cervical with Spinal Curvature, Malignancy or 9+ Fusions with CC MS-DRG 458 Spinal Fusions Except Cervical with Spinal Curvature, Malignancy or 9+ Fusions without CC/MCC The principal diagnosis codes that will lead to this DRG assignment are the following: Tuberculosis of bones and joints, vertebral column, bacteriological or histological examination unknown (at present) Tuberculosis of bones and joints, vertebral column, tubercle bacilli not found (In sputum) by microscopy, but found by bacterial culture Tuberculosis of bones and joints, vertebral column, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically Malignant neoplasm of vertebral column, excluding sacrum and coccyx Secondary malignant neoplasm of bone and bone marrow Benign neoplasm of bone and articular cartilage; vertebral column, excluding sacrum and coccyx Neoplasm of uncertain behavior of other and unspecified sites and tissues; Bone and articular cartilage Neoplasms of unspecified nature; bone, soft tissue, and skin Acute osteomyelitis of other specified sites Chronic osteomyelitis of other specified sites Unspecified osteomyelitis of other specified sites Juvenile osteochondrosis of spine Pathologic fracture of vertebrae Adolescent postural kyphosis Kyphosis (acquired) (postural) Kyphosis due to radiation Kyphosis, postlaminectomy Kyphosis (acquired), other Lordosis (acquired) (postural) Lordosis, postlaminectomy Other postsurgical lordosis Lordosis (acquired), other Scoliosis [and kyphoscoliosis], idiopathic Resolving infantile idiopathic scoliosis Progressive infantile idiopathic scoliosis Scoliosis due to radiation Thoracogenic scoliosis Other kyphoscoliosis and scoliosis Other curvatures of spine Unspecified curvature of spine Congenital scoliosis Osteogenesis imperfect The secondary diagnoses that will lead to DRG 456, 457 or 458 assignment are: Curvature of spine, unspecified Curvature of spine associated with other conditions, kyphosis Curvature of spine associated with other conditions, lordosis Curvature of spine associated with other conditions, scoliosis Page 12 of 15

13 Procedure code: Fusion or refusion of 9 or more vertebrae MS-DRG 459 Spinal Fusion Except Cervical with MCC MS-DRG 460 Spinal Fusion Except Cervical without MCC Spinal Fusions Include any of the following procedure codes: Fusion, spinal NOS Fusion, anterior column, dorsal/dorsolumbar, anterior technique Fusion, posterior column, dorsal/dorsolumbar, posterior technique Fusion, anterior column, lumbar/lumbosacral, anterior technique Fusion, posterior column, lumbar/lumbosacral, posterior technique Fusion, anterior column, lumbar/lumbosacral, posterior technique Spinal Refusions Include any of the following procedure codes: Refusion, spinal NOS Refusion, anterior column, dorsal/dorsolumbar, anterior technique Refusion, posterior column, dorsal/dorsolumbar, posterior technique Refusion, anterior column, lumbar/lumbosacral, anterior technique Refusion, posterior column, lumbar/lumbosacral, posterior technique Refusion, anterior column, lumbar/lumbosacral, posterior technique Refusion, spinal NEC MS-DRG 471 Cervical Spinal Fusion with MCC MS-DRG 472 Cervical Spinal Fusion with CC MS-DRG 473 Cervical Spinal Fusion without CC/MCC Spinal Fusions Include any of the following procedure codes: Fusion, atlas-axis Fusion, anterior column, other cervical, anterior technique Fusion, posterior column, other cervical, posterior technique Spinal Refusions Include any of the following procedure codes: Refusion, atlas-axis Refusion, anterior column, other cervical, anterior technique Refusion, posterior column, other cervical, posterior technique MS-DRG 477 Biopsies of Musculoskeletal and Connective Tissue with MCC MS-DRG 478 Biopsies of Musculoskeletal and Connective Tissue with CC MS-DRG 479 Biopsies of Musculoskeletal and Connective Tissue without CC/MCC (If a biopsy is performed at the same operative session as a vertebroplasty or percutaneous vertebral augmentation, the encounter is grouped to DRG 477, 478 or 479) Other repair or plastic operations on bone Percutaneous vertebroplasty Percutaneous vertebral augmentation Page 13 of 15

14 MS-DRG 490 Back and Neck Procedures except Spinal Fusion with CC/MCC or disc device/neurostim Include any of the following procedure codes and procedure codes listed for MS-DRG 491: Insertion of other spinal devices Insertion of total spinal disc prosthesis, cervical Insertion of total spinal disc prosthesis, lumbosacral Insertion or replacement of interspinous process device(s) Insertion or replacement of pedicle-based dynamic stabilization device(s) Insertion or replacement of facet replacement device(s) MS-DRG 491 Back and Neck Procedures except Spinal Fusion without CC/MCC Include any of the following procedure codes: Reopening, laminectomy site Exploration and decompression, other spinal canal 03.1 Division, intraspinal nerve root Biopsy, spinal cord or spinal meninges Procedure, diagnostic other spinal cord and spinal cord structures 03.4 Excision or destruction, lesion, spinal cord or spinal meninges Repair, vertebral fracture Repair and plastic operation, other spinal cord structures 03.6 Lysis, adhesions, spinal cord and nerve root Insertion or replacement, spinal neurostimulator Removal, spinal neurostimulator Revision, spinal thecal shunt Removal, spinal thecal shunt Operation, other, spinal cord and spinal canal structures Excision or destruction, intervertebral disc, unspecified Excision, intervertebral disc Repair of the annulus fibrosus with graft or prosthesis Other and unspecified repair of the annulus fibrosus Destruction, other intervertebral disc Insertion of spinal disc prosthesis, not otherwise specified Insertion of partial spinal disc prosthesis, cervical Insertion of spinal disc prosthesis, thoracic Insertion of partial spinal disc prosthesis, lumbosacral Revision or replacement of artificial spinal disc prosthesis, cervical Revision or replacement of artificial spinal disc prosthesis, thoracic Revision or replacement of artificial spinal disc prosthesis, lumbosacral Revision or replacement of artificial spinal disc prosthesis, not otherwise specified MS-DRG 515 Other Musculoskeletal System and Connective Tissue O.R. Procedure with MCC MS-DRG 516 Other Musculoskeletal System and Connective Tissue O.R. Procedure with CC MS-DRG 517 Other Musculoskeletal System and Connective Tissue O.R. Procedure without CC/MCC Percutaneous vertebroplasty Percutaneous vertebral augmentation Revision of interspinous process device(s) Revision of pedicle-based dynamic stabilization device(s) Revision of facet replacement device(s) Page 14 of 15

15 MS-DRG 28 Spinal Procedures with MCC MS-DRG 29 Spinal Procedures with CC or spinal neurostimulators MS-DRG 30 Spinal Procedures without CC/MCC 03.0X Exploration and decompression, spinal canal structures 03.1 Division, intraspinal nerve root 03.2 Chordotomy Biopsy, spinal cord or spinal meninges Procedure, diagnostic, other, spinal cord and spinal canal structures 03.4 Excision or destruction, lesion, spinal cord or spinal meninges 03.5 Repair, spinal cord structures 03.6 Lysis, adhesions, spinal cord and nerve roots Operation, other spinal cord and spinal canal structures Excision or destruction, intervertebral disc, unspecified Excision, intervertebral disc Repair of the annulus fibrosus with graft or prosthesis Other and unspecified repair of the annulus fibrosus Destruction, other, intervertebral disc 81.0x Fusion, spinal 81.3x Revision, spinal Insertion of other spinal devices Insertion of spinal disc prosthesis, not otherwise specified Insertion of partial spinal disc prosthesis, cervical Insertion of total spinal disc prosthesis, cervical Insertion of spinal disc prosthesis, thoracic Insertion of partial spinal disc prosthesis, lumbosacral Insertion of total spinal disc prosthesis, lumbosacral Revision or replacement of artificial spinal disc prosthesis, cervical Revision or replacement of artificial spinal disc prosthesis, thoracic Revision or replacement of artificial spinal disc prosthesis, lumbosacral Revision or replacement of artificial spinal disc prosthesis, not otherwise specified Implantation of interspinous process decompression device(s) Insertion or replacement of pedicle-based dynamic stabilization device(s) CC Complications and/or comorbidities, MCC Major Complications and/or comorbidities The information in this document was obtained from third party sources and is subject to change without notice, including as a result in 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. For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at Page 15 of 15