Introduction to Spine Surgery Billing

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Introduction to Spine Surgery Billing
It seems like coding spine cases is as
complicated as doing the surgery. Coders must
have in-depth knowledge of the primary procedures
and additional procedures along with affected
areas to code appropriately for spine surgery
billing. In this article, we shared basic
principles of spine surgery billing which can use
as a reference while billing for spine
procedures. Introduction to Spine Surgery
Billing Deciding Primary Surgery For spine
surgery billing purposes, the surgeon must select
the most complex surgery being performed as the
primary surgery. If the surgeon is planning a
single-level lumbar spine fusion with
decompression, the surgeon will select the
single-level fusion procedure. The surgeon does
not need to request separate authorization for
the decompression procedure being performed as
part of the lumbar fusion surgery. This is
included in the lumbar fusion request. Or if a
surgeon is planning a laminectomy with a
microdiscectomy, the surgeon will select the
lumbar decompression procedure. The surgeon does
not need to request separate authorization for
the microdiscectomy procedure. Accurate Codes
for Decompression/Discectomy
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Introduction to Spine Surgery Billing
Decompression is the general term to describe the
removal of the spinal disk, bone, or tissue
causing pressure and pain. Often, this is the
only procedure performed. For spine surgery
billing purposes, identify which
decompression/discectomy activity the surgeon
performed. Then, choose an appropriate standalone
code and any associated add-on codes for the
decompression. Note that, corpectomy (removal of
part or all of a vertebral body) codes include
the discectomy at the level above and below the
corpectomy. Discectomy is a single, standalone
code, such as 63030 Laminotomy (hemilaminectomy),
with decompression of nerve root(s), including
partial facetectomy, foraminotomy and/or excision
of the herniated intervertebral disc 1
interspace, lumbar. While decompression of the
spinal canal can be coded per vertebral segment,
or per level of foraminotomy. Billing for Fusion
/ Arthrodesis Arthrodesis is the fusion, or
permanent joining, of a joint, or point of union
of two musculoskeletal structures, such as two
bones. If the fusion (arthrodesis) is performed
then choose the standalone CPT code for the
fusion (i.e., arthrodesis / the joining of two or
more vertebrae). Fusion is the merging of
adjacent parts therefore, coding a single fusion
segment involves two adjacent vertebral segments.
Differentiate whether the approach was posterior
or anterior to choose the correct arthrodesis
code(s). The standalone
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Introduction to Spine Surgery Billing
code covers the first segment of fusion, and the
associated add-on codes are used for additional
levels of fusion. As a fusion is performed, you
must include a bone graft code. As with other
graft codes in CPT, the spinal bone graft codes
are reported for harvesting the bone graft. The
work of placing the bone graft is included in the
arthrodesis/fusion codes. All spinal bone graft
codes are add-on codes. CPT guidelines allow for
reporting each bone graft code once per operative
session. From the operative note, determine
whether the bone graft was an allograft or an
autograft and whether it was a morselized (bits
or pieces) or structural (wedge or chunk) bone.
It helps to know what the bone type documented in
the operative note looks like. Billing for
Instrumentation/ Medical Device If the
instrumentation is used in the fusion then choose
the appropriate add-on code(s) for the
instrumentation, also known as hardware. Review
the operative note to determine where the
instrument was used, and whether it was
non-segmental, segmental, or intervertebral.
Posterior instrumentation is categorized as
non-segmental or segmental.  Choose anterior
instrumentation codes based on the number of
vertebral segments the hardware (typically, a
plate) spans. The instrumentation (medical
device), bone grafts, and bone marrow aspiration
are procedures commonly performed in conjunction
with single or multiple-level
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Introduction to Spine Surgery Billing
lumbar or cervical spines. Billing Additional
Procedures If the other procedures are performed
in addition to decompression then code for these
other procedures. Examples include Use of an
operating microscope for microdissection Bone
marrow harvest in a separate surgical exposure
such as from the iliac crest, for the
autograft Use of a stereotactic navigation system
for pedicle screw placement With the
above-mentioned guidelines, you can capture
charges for spine procedures correctly with
errors. Medical Billers and Coders (MBC) is a
leading medical billing company providing
complete medical billing and coding services. If
you need help with spine surgery billing, email
us at info_at_medicalbillersandcoders.com or call
us at 888-357-3226.  Reference Spine Surgery
Coding Made Simple 2019 Spine Coding Basics