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Hospital > Frequently Asked Questions
- How do you code for a cervical disc arthroplasty using the PRESTIGE® Cervical Disc?
Answer:
Code 84.62 Insertion of total spinal disc prosthesis, cervical should be reported. This procedure will group to MS-DRG 490.
- What is the procedure code for insertion of an intervertebral implant between the spinous processes? This procedure is done in order to decompress the spinal canal, usually for a diagnosis of spinal stenosis.
Answer:
Assign code 84.80 "implantation of interspinous process device" for the insertion of the intervertebral implant. Code 03.09 should be assigned for the exploration and decompression of the spinal canal, if performed.
- Should two codes be assigned when a decompression laminectomy and facetectomy are performed at the same level?
Answer:
Only one code should be assigned for a decompression laminectomy and facetectomy of the same level. Suggest code 03.09 for "Other exploration and decompression of the spinal cord." Code 77.89 should not be billed as there is an exclusion note under the code 77.x heading stating that this range of codes excludes laminectomy for decompression (03.09).
- Are both discectomy and removal of disc fragments included in code 80.51, "Excision of intervertebral disc?"
Answer:
Yes, code 80.51 includes both components, the excision of the disc as well as the removal of disc fragments.
- Should two codes be assigned for excision of a herniated disc and a decompressive laminectomy performed during the same operative session?
Answer:
Codes 03.09 and 80.51 should never be assigned together when performed at the same site and session. If these two procedures are performed at different vertebral levels, then it is appropriate to assign both codes together. Remember that the decompressive laminectomy code is included in 80.51. If the decompression is the only procedure performed, then assign code 03.09 for "Other exploration and decompression of spinal cord."
- What codes should be assigned for the following procedures, all performed at the same operative session: Laminectomy at L3 – 4, hemilaminectomy at L2 and L5, bilateral facetectomies at L3 – 4 and L4 – 5, foraminotomies at L3 – 4 and L5, and spinal fusion using iliac crest bone graft at L3-4 and L5?
Answer:
Only two codes are warranted in this case: 81.08, "Lumbar and lumbosacral fusion, posterior technique", and code 77.79, "Excision for bone for graft, other", to identify the L3, L4, and L5 spinal fusions using iliac crest for grafting and the facetectomies. The laminectomy and foraminotomies are considered integral to the operative approach for the spinal fusion and should not be coded separately.
- How should the diagnosis pseudoarthrosis be coded when it develops following an arthrodesis procedure? ICD-9-CM code 733.82 describes pseudoarthrosis secondary to nonunion of a fracture. Since the above scenario does not involve a fracture, how should this type of pseudoarthrosis be coded?
Answer:
Pseudoarthrosis, or ankylosis, of a joint following arthrodesis should be assigned code V45.4 for "arthrodesis status." If the site of previous arthrodesis required a refusion or revision procedure secondary to a complication of the arthrodesis, then code 996.49 should be assigned.
- Please provide the correct diagnosis code assignment for a lateral disc herniation.
Answer:
Select codes from the 722.0 – 722.2 series in order to assign a diagnosis code for displacement of intervertebral disc.
- What is the correct code for a percutaneous suction discectomy procedure?
Answer:
Assign code 80.59, "Other destruction of intervertebral disc," for a percutaneous suction discectomy procedure.
- Please explain the "Excludes" notes under 723 and 724. Does it mean that disorders due to intervertebral disc disorders or spondylosis are included in codes 721.0 – 722.91 or do both conditions need to be coded?
Answer:
Signs and symptoms secondary to disorders such as spondylosis and allied disorders (721.0 – 721.91) or due to intervertebral disc disorders, such as herniated or degenerative discs (722.0 – 722.93), are included in codes from the 721 – 722 range.
- Please explain the postlaminectomy syndrome diagnosis.
Answer:
Postlaminectomy syndrome sometimes occurs following the laminectomy procedure. In this syndrome, there is formation of excessive scar tissue that results in chronic pain for the patient. The code for postlaminectomy syndrome is 722.8X. The physician must clearly document that the patient's pain is secondary to the scar tissue formation from previous spinal surgery.
- What procedure codes should be assigned for a hemilaminotomy procedure done for excision of an extradural cyst/mass that is consistent with a synovial cyst?
Answer:
Code 03.09, "Other exploration and decompression of spinal canal," and 83.39, "Excision of lesion of other soft tissue" should both be assigned for hemilaminotomy for excision of a synovial cyst. Note that the hemilaminotomy/hemilaminectomy is not considered the approach and thus should be coded.
- How should a percutaneous vertebroplasty procedure be coded when performed at multiple levels?
Answer:
Code 81.65 should be used to report a vertebroplasty procedure.
If a percutaneous vertebroplasty is performed in the outpatient setting, CPT codes 22520 "thoracic" and 22521 "lumbar" are reported for single level vertebroplasties, unilateral or bilateral. If performed on additional thoracic or lumbar bodies during the same operative episode, add-on code 22522 should be used as an additional code for the respective vertebral body. For example, if a vertebroplasty is performed at L1 and L2 codes 22521 (L1) and 22522 (L2) should be reported.
- The physician performed a bone biopsy in conjunction with a percutaneous vertebral augmentation. Can I code the bone biopsy separately?
Answer:
Yes, per Coding Clinic, 3rd Quarter 2006, a bone biopsy can be reported in addition to the percutaneous vertebral augmentation code.
- How do you code a percutaneous vertebral augmentation procedure? Our coders understand this procedure is very similar to the vertebroplasty codes.
Answer:
The appropriate ICD-9-CM procedure code is 81.66.
Percutaneous vertebral augmentation is an osteoplastic type of procedure that involves reshaping of the vertebra. Regardless of whether or not a compression fracture is reduced, only code 81.66 is required for assignment; do not also assign code 81.65 for this procedure.
For CPT procedure coding, for the outpatient setting is as follows:
| 22523 | Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., Kyphoplasty); thoracic |
| 22524 | Lumbar |
| 22525 | Each additional thoracic or lumbar vertebral body |
- How are "laminoplasty" procedures coded?
Answer:
Assign a code 03.09, Other exploration and decompression of spinal canal, for the laminoplasty.
The CPT code for laminoplasty is as follows:
| 63050 | Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; |
| 63051 | With reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fxation devices (eg, wires, suture, mini-plates), when performed)
* Please note: Laminoplasty performed on regions other than cervical should be coded using 22899.
** Laminoplasty procedure codes are a Status Indicator "C" and are not reimbursed in the outpatient setting. |
- Is it necessary to code for diagnoses and procedures that do not change the MS-DRG?
Answer:
Yes, it is necessary to code for diagnoses and procedures that do not change the MS-DRG. The overall basis of ICD-9-CM is for capturing data. While not all diagnoses and procedures affect reimbursement they continue to be important in gathering statistical information which may effect future decisions regarding reimbursement as well as future enhancements to the coding system. (See Case Mix Index Chapter 3.2)
- How do you code for the insertion of MASTERGRAFT ® Ceramic Granules?
Answer:
Report the insertion of bone void fllers using ICD-9-CM procedure code 84.55.
- What are the codes and the corresponding MS-DRG for the placement of an artifcial disc?
Answer:
The codes for disc replacement are:
| 84.60 | Insertion of spinal disc prosthesis, not otherwise specifed |
| 84.61 | Insertion of partial spinal disc prosthesis, cervical |
| 84.62 | Insertion of total spinal disc prosthesis, cervical (MS-DRG 490 only) |
| 84.63 | Insertion of spinal disc prosthesis, thoracic |
| 84.64 | Insertion of partial spinal disc prosthesis, lumbosacral |
| 84.65 | Insertion of total spinal disc prosthesis, lumbosacral (MS-DRG 490 only) |
| 84.66 | Revision or replacement of artifcial spinal disc prosthesis, cervical |
| 84.67 | Revision or replacement of artifcial spinal disc prosthesis, thoracic |
| 84.68 | Revision or replacement of artifcial spinal disc prosthesis, lumbosacral |
| 84.69 | Revision or replacement of artifcial spinal disc prosthesis, not otherwise specifed |
| CMS has mapped these procedure codes to MS-DRG 490 or 491. |
- Does Medtronic's Spinal and Biologics business have a list of C-codes for hospitals to use?
Answer:
C-codes report drugs, biologicals and devices eligible for transitional pass-through payments and for items classifed in new technology ambulatory payment classifcations (APCs) under the Outpatient Prospective Payment System (OPPS). While there may be C-codes available that may correctly describe some of Medtronic's Spinal and Biologics products, Medicare has deemed all instrumented spinal procedures to be "inpatient only." Therefore, because C-codes represent technology utilized in the outpatient setting and instrumented spine procedures must be performed in the inpatient setting, there are no C-codes for Medtronic's Spinal and Biologics products. The complete listing of C codes can be found on the Center for Medicare & Medicaid Services' website, http://cms.hhs.gov.
- How is a discectomy procedure performed with the METRx ™ Micro Discectomy System coded?
Answer:
ICD-9-CM code 80.51, Excision of intervertebral disc should be assigned for inpatient procedures.
For the outpatient setting the CPT codes are as follows:
| 63030 | Laminotomy, with decompression of nerve roots, including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, Lumbar (including open or endoscopically-assisted approach) |
| 63035 | Each additional interspace, cervical or lumbar (list separately in addition to the primary procedure). |
- Is there a separate code for the METRx ™ instruments?
Answer:
There are no separately reportable codes for the instruments. For inpatient hospital procedures, ICD-9-CM code 80.51, excision of intervertebral disc, would be assigned.
The METRx™ MicroDiscectomy System is composed of bayoneted surgical tools with various-sized metal tubes used to create and maintain openings to spinal elements. Fundamental to this system are specially designed metal tubes, called dilators, which progressively increase in diameter size. The system's retractor tubes maintain the opening while the surgeon uses specially designed surgical tools to reach and remove spinal elements that are causing pain.
- There seems to be lots of confusion regarding 360° fusions. Would you please clarify the clinical components that constitute a 360° spinal fusion?
Answer:
Clinically, a 360° spinal fusion is an anterior and posterior fusion of a vertebra performed during the same operative session. There are two ways to accomplish a 360° fusion. In the conventional one, an incision is made in the patient's front (abdominal region) to do the anterior fusion, then the patient is fipped over and a second incision is made in the back to do the posterior fusion. The second method is a single incision approach, where both the anterior and posterior faces of the vertebra are reached through one incision. Depending on the patient's clinical situation, this single incision can be either posterior or transforaminal but not anterior.
A 360° spinal fusion requires that both the front and back of the vertebra be fused. Fusion is a "welding" process by which two or more vertebrae are fused together with bone grafts, a bone equivalent, or a bone substitute into a single solid bone. In a 360° fusion, interbody fusion devices are placed between the vertebrae for the anterior fusion. Then for the posterior fusion, bone is laid along the transverse processes of the vertebrae; this is sometimes called laying bone "in the gutters". Alternately, some surgeons accomplish the posterior fusion by "roughing up" the facets and then laying the resulting bone chips posteriorly.
Spinal instrumentation, like screws and rods and plates, is almost always used posteriorly as well. Just note that the instrumentation is used for fxation and stability, not fusion per se. Regardless of the instrumentation, it's the use of bone grafts or chips, a bone equivalent, or a bone substitute that actually constitutes the fusion. For a 360° fusion, these bone devices must be used both front and back, with or without instrumentation.
The material presented in these FAQs is provided to our customers to assist them in obtaining correct and appropriate coverage and reimbursement for healthcare goods and services. To the best of our knowledge, the information contained within was correct as of the date of publication. However, there can be no assurances that it will not become outdated, without notice from Medtronic Sofamor Danek, or that the government or other payers may not differ with the guidance contained in the FAQs. The responsibility for correct coding, reimbursement submissions, and following device labeling lies with the healthcare provider. We urge you to consult with your coding advisors to resolve any billing questions that you might have.
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