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Spine surgery is performed by orthopaedic surgeons, neurosurgeons, and even cardio-thoracic and general surgeons. The trick to coding these cases is identifying the anatomy involved and then assigning the appropriate CPT® codes based on matching the CPT® codes with those areas of the spine. There is frequently a combination of codes used, and understanding the surgical approach is also critical in coding these cases.<br><br>Areas Covered in the session:<br>The expectations of this conference are that the attendee upon the completion of the conference should have an understanding of coding spine surgery utilizing 20000 codes as well as 60000 codes of CPT® the 2018 changes that are affecting spine surgery coding, as well as review current guidelines for services for Medicare and other commercial insurance carriers.<br><br>Why should you attend?<br>Identifying the surgical approach to determine the CPT® codes ranges.<br>Understanding the difference in coding for vertebral segment vs. interspace.<br>Modifier assignment for assistants, co-surgery, and staged procedures.<br>Laminectomy or laminotomy, which one to choose.<br>Interchangeable add-on to report specific levels of the spine involved to avoid denials for duplicate claim lines.<br>New codes for spine procedures in 2018.<br>NCCI policy changes that affect spinal instrumentation. New rules in 2018!<br><br>E-mail us at cs@onlineaudiotraining.com or call 1-800-935-3714 to buy full webinar.
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Spine Surgery Coding Lynn M. Anderanin, CPC,CPPM, CPC-I,CPMA,COSC 1
Agenda • Anatomy • Coding Tips • Surgical Procedures – Excision – Decompression – Fusion – Artificial Discs – Bone grafts – Instrumentation • Modifiers 2
Spine Anatomy • 7 cervical (neck) vertebrae, • 12 thoracic (chest) vertebrae, • 5 lumbar (back) vertebrae, and • 5 fused vertebra that make up the sacrum • 4 fused vertebra that make up the coccyx 3
Good diagrams of the parts of a vertebra can be found at http://www.cedars- sinai.edu/Patients/Programs-and- Services/Spine-Center/Anatomy-of-the- Spine/Vertebrae-of-the-Spine.aspx 4
General Notes • Approach • Number of levels involved • Appropriate use of modifiers • Co-Surgery 5
Vertebral Segment vs. Interspace • A vertebral segment describes the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae. • A vertebral interspace is the non-body compartment between two adjacent vertebral bodies, which contains the intervertebral disk, and includes the nucleus pulposus, annulus fibrosus, and two cartilagenous endplates. CPT®Definition 6
Counting Levels An interspace is between two vertebra. Example: L1-L3 Vertebral segment 3 - L1,L2,L3 Interspace 2 - between L1 and L2 between L2 and L3 7
Surgical Procedures • Excise and/or Decompress • Fusion, reconstruct, or replace • Insertion • Stabilization 8
Excision • Codes found in 20000 or 60000 series – Intrinsic bony lesion-22100-22103, 22110-22116 – Osteotomy-22206-22226 – Kyphectomy- 22818-22819 – Discectomy- 63075-63078 – Vertebral corpectomy-63081-63103 9
Partial Vertebral Corpectomy • Parenthetical above 63075, 63101, and 63300 • Amount of vertebra removed defined: – Cervical- at least one half removed – Thoracic or lumbar- at least one third removed 10
Decompression • Operative report should describe that a nerve/spinal cord is being decompressed – Laminectomy-63001-63017,63045-63048 – Laminotomy- 63020-63044 – Laminoplasty-63050-63051 – Transpedicular approach-63055-63057 – Costovertebral approach-63064-63066 11
Laminotomy vs. Laminectomy LAMINOTOMY LAMINECTOMY Less than 50% lamina 50% or more lamina Disc disorders Stenosis 12
