CPT® Assistant May 2018 / Volume 28 Issue 5 9
This correction aligns the coding advice with historical
precedent published prior to the incorrect revisions in
advice given in the October 2016 FAQ.
The following is the corrected coding advice:
Surgery: Nervous System
Question: The procedure described in code 63047 was performed
for decompression, which was documented in the
operative note. In addition, the procedure described in code
22633 was also performed at the same interspace. How should
this be reported?
Answer: Codes 22633 and 63047 may be reported for the
same interspace when additional work is required to
complete a decompression at a single spinal level. It is also
appropriate to report codes 22633 and 63047, if the two
procedures are performed at different interspaces. Modifier
59, Distinct Procedural Service, should then be appended to
indicate that these are two distinct procedures.
Coding Correction: Reporting Codes 22633
and 63047
In the Frequently Asked Questions (FAQ) section (page 11)
of the October 2016 issue of CPT® Assistant, the Surgery:
Nervous System answer incorrectly stated that codes 22633,
Arthrodesis, combined posterior or posterolateral technique
with posterior interbody technique including laminectomy and/
or discectomy sufficient to prepare interspace (other than for
decompression), single interspace and segment; lumbar, and
63047, Laminectomy, facetectomy and foraminotomy (unilateral
or bilateral with decompression of spinal cord, cauda
equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]),
single vertebral segment; lumbar, may not be reported
for the same interspace. On further analysis of this issue,
it was demonstrated that this recommendation was inconsistent
with previously published CPT® Assistant advice,
which is that codes 22633 and 63047 may be reported for
the same interspace when additional work is required to
complete a decompression at a single spinal level. It is also
appropriate to report codes 22633 and 63047, if the two
procedures are performed at different interspaces. Modifier
59, Distinct Procedural Service, should then be appended to
indicate that these are two distinct procedures.
CPT CODING EXAMPLES
FUSION PROCEDURES
Anterior Lumbar Interbody Fusion (ALIF)
| ALIF with Posterior Instrumentation | ||
| Procedure Description CPT ® | Comments | |
| Anterior Interbody Fusion, Lumbar
22558 +22585 |
fusion of first interspace fusion of each additional interspace |
|
| Application of Biomechanical Device (e.g.,cages)
+22853 |
assigned once for each interspace (not per device) |
|
| Posterior Instrumentation
+22840 +22842 +22843 +22844 |
non-segmental instrumentation segmental; spanning 3 – 6 vertebral segments segmental; spanning 7 – 12 vertebral segments segmental; spanning 13+ vertebral segments |
|
| Use of Bone Graft: | ||
| Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision) Autograft (structural, separate incision) |
+20930
+20931 +20936 +20937 +20938 |
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest e.g., bone cortex graft from iliac crest |
| ALIF with Anterior Instrumentation | |
| Procedure Description CPT ® | Comments |
| Anterior Interbody Fusion, Lumbar 22558
+22585 |
fusion of first interspace
fusion of each additional interspace |
| Application of Biomechanical Device (e.g.,cages) +22853 | assigned once for each interspace (not per device) |
| Anterior Instrumentation +22845
+22846 +22847 |
spanning 2 – 3 vertebral segments spanning 4 – 7 vertebral segments spanning 8 or more vertebral segments |
| Use of bone graft: | |
| Allograft (morselized) +20930
Allograft (structural) +20931 Autograft (rib/lamina/spinous process, same incision) +20936 Autograft (morselized, separate incision) +20937 Autograft (structural, separate incision) +20938 |
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest e.g., bone cortex graft from iliac crest |
| ALIF with rhBMP Bone Graft and LT-CAGE Lumbar Tapered Fusion Device, Single Level | |
| Procedure Description CPT ® | Comments |
| Anterior Interbody Fusion, Lumbar 22558 | fusion of single level interspace |
| Application of Biomechanical Device (e.g., cages) +22853
Placement of Osteopromotive Material +20930 |
assigned once for each interspace (not per device)
used for rhBMP bone graft |
| Posterolateral Fusion with Posterior Instrumentation | ||
| Procedure Description | CPT ® | Comments |
| Posterolateral Fusion, Lumbar | 22612
+22614 |
fusion of first level
fusion of each additional segment |
| Posterior Instrumentation | +22840
+22842 +22843 +22844 |
non-segmental instrumentation
segmental; spanning 3– 6 vertebral segments segmental; spanning7–12 vertebral segments segmental; spanning 13+ vertebral segments |
| Use of Bone Graft: | ||
| Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision) Autograft (structural, separate incision) |
+20930
+20931 +20936 +20937 +20938 |
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest e.g., bone cortex graft from iliac crest |
Posterior Lumbar Interbody Fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF)
| PLIF or TLIF with Posterior Instrumentation | ||
| Procedure Description | CPT ® | Comments |
| Posterior Interbody Fusion, Lumbar | 22630
+22632 |
fusion of first interspace
fusion of each additional interspace |
| Application of Biomechanical Device (e.g.,cages) | +22853 | assigned once for each interspace (not per device) |
| Posterior Instrumentation | +22840
+22842 +22843 +22844 |
non-segmental instrumentation
segmental; spanning 3– 6 vertebral segments segmental; spanning7–12 vertebral segments segmental; spanning 13+ vertebral segments |
| Use of bone graft: | ||
| Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision) Autograft (structural, separate incision) |
+20930
+20931 +20936 +20937 +20938 |
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest e.g., bone cortex graft from iliac crest |
| Note: Laminectomy codes 63030, 63024, and 63047 are bundled into fusion code 22630 per NCCI edits and policy, which do not allow separate payment when performed at the same interspace. CPT® Assistant (January 2001) states that laminectomy
specifically for the purpose of decompression, beyond the work of preparing the interspace for fusion, may be separately coded. |
||
| PLIF with Posterior Instrumentation Via METRx System / CD Horizon Sextant System | ||
| Procedure Description CPT ® | Comments | |
| Posterior Interbody Fusion, Lumbar | 22630
+22632 |
fusion of first interspace
fusion of each additional interspace |
| Application of Biomechanical Device (e.g.,cages) | +22853 | assigned once for each interspace (not per device) |
| Posterior Instrumentation | +22840
+22842 |
non-segmental instrumentation
segmental; spanning 3– 6 vertebral segments |
| Use of Bone Graft: | ||
| Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision) Autograft (structural, separate incision) |
+20930
+20931 +20936 +20937 +20938 |
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest e.g., bone cortex graft from iliac crest |
| Note: Laminectomy codes 63030, 63024, and 63047 are bundled into fusion code 22630 per NCCI edits and policy, which do not allow separate payment when performed at the same interspace. CPT® Assistant (January 2001) states that laminectomy
specifically for the purpose of decompression, beyond the work of preparing the interspace for fusion, may be separately coded. |
||
| Classic 360� Procedure: ALIF and Posterolateral Fusion | |||
| Procedure Description CPT ® | Comments | ||
| Posterolateral Fusion, Lumbar 22612
+22614 |
posterior fusion of first level
posterior fusion of each additional segment |
||
| Anterior Interbody Fusion, Lumbar | 22558
+22585 |
anterior fusion of first interspace
anterior fusion of each additional interspace |
|
| Posterior Instrumentation +22840
+22842 +22843 +22844 |
non-segmental instrumentation
segmental; spanning 3– 6 vertebral segments segmental; spanning7–12 vertebral segments segmental; spanning 13+ vertebral segments |
||
| Application of Biomechanical Device (e.g.,cages) | +22853 | assigned once for each interspace (not per device) | |
| Use of Bone Graft: | |||
| Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision) Autograft (structural, separate incision) |
+20930
+20931 +20936 +20937 +20938 |
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest e.g., bone cortex graft from iliac crest |
|
Single Incision 360 Fusion: PLIF/TLIF and Posterolateral Fusion
Procedure Description CPT ® Comments
Combined Fusion, Posterolateral fusion, with Posterior
22633
fusion of first interspace and segment
Interbody Fusion
+22634 fusion of each additional interspace/segment
Posterior Instrumentation +22840
+22842
+22843
+22844
Application of Biomechanical Device (e.g.,cages) +22853
Use of Bone Graft:
non-segmental instrumentation
segmental; spanning 3– 6 vertebral segments
segmental; spanning7–12 vertebral segments
segmental; spanning 13+ vertebral segments
assigned once for each interspace (not per device)
Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision)
Autograft (structural, separate incision)
+20930
+20931
+20936
+20937
+20938
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest
e.g., bone cortex graft from iliac crest
Note: Laminectomy codes 63030, 63024, and 63047 are bundled into fusion code 22630 per NCCI edits and policy, which do not allow separate payment when performed at the same interspace. CPT® Assistant (January 2001) states that laminectomy
specifically for the purpose of decompression, beyond the work of preparing the interspace for fusion, may be separately coded.
Direct Lateral Interbody Fusion (DLIF)
| DLIF with Anterior Instrumentation | |||
| Procedure Description | CPT ® | Comments | |
| Anterior Interbody Fusion, Lumbar | 22558
+22585 |
fusion of first interspace
fusion of each additional interspace |
|
| Application of Biomechanical Device (e.g.,cages) | +22853 | assigned once for each interspace (not per device) | |
| Anterior Instrumentation | +22845
+22846 +22847 |
spanning 2-3 vertebral segments spanning 4-7 vertebral segments spanning 8 or more vertebral segments | |
| Use of Bone Graft: | |||
| Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision) Autograft (structural, separate incision) |
+20930
+20931 +20936 +20937 +20938 |
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest e.g., bone cortex graft from iliac crest |
|
| Note: DLIF is a form of anterior lumbar interbody fusion. | |||
| Anterior Cervical Discectomy with Interbody Fusion (ACDF) | ||
| Procedure Description | CPT ® | Comments |
| Anterior Interbody Fusion, with Discectomy and Decompression; Cervical Below C2 | 22551
+22552 |
fusion of first interspace
fusion of each additional interspace |
| Anterior Instrumentation | +22845
+22846 +22847 |
spanning 2 – 3 vertebral segments spanning 4–7 vertebral segments spanning 8 or more vertebral segments |
| Use of Bone Graft: | ||
| Allograft (morselized)
Allograft (structural) |
+20930
+20931 |
e.g., bone chips
e.g., bone dowel |
| Autograft (rib/lamina/spinous process, same incision)
Autograft (morselized, separate incision) Autograft (structural, separate incision) |
+20936
+20937 +20938 |
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest
e.g., bone cortex graft from iliac crest |
|
Note: Do not report anterior interbody cervical fusion codes 22554 or 22585 with anterior discectomy codes 63075 or 63076 even if performed by different physicians. To report anterior cervical discectomy and interbody fusion at the same level during the same session, use 22551. |
||
Anterior Cervical Fusion with Corpectomy (e.g., for burst fracture)
Procedure Description CPT ® Comments
Anterior Interbody Fusion, Cervical
22554
+22585
fusion of first interspace
fusion of each additional interspace
Vertebral Corpectomy, Cervical (e.g., for burst fracture) 63081
corpectomy of single segment
+63082 corpectomy of each additional segment
Application of Biomechanical Device (e.g., cages)
Anterior Instrumentation
Use of Bone Graft:
Allograft (morselized) Allograft (structural)
Autograft (rib/lamina/spinous process, same incision) Autograft (morselized, separate incision)
Autograft (structural, separate incision)
+22854
+22845
+22846
+22847
+20930
+20931
+20936
+20937
+20938
assigned once for each contiguous defect (e.g., C4-C6)
spanning 2–3 vertebral segments spanning 4–7 vertebral segments spanning 8 or more vertebral segments
e.g., bone chips e.g., bone dowel
e.g., bone from laminectomy via same incision as fusion e.g., crushed bone harvested from iliac crest
e.g., bone cortex graft from iliac crest
Note: Code +22854 for application of biomechanical device is used only when it is applied to a vertebral defect resulting from concurrent corpectomy (partial or complete vertebral body resection) accompanied by spinal fusion. To qualify as a cervical vertebral corpectomy for coding purposes, at least one-half of the vertebral body must be removed (CPT Assistant, April 2016).
OTHER SPINAL PROCEDURES
| Laminectomy, Lumbar | |||
| Procedure Description | CPT ® | Comments | |
| Laminectomy without Facetectomy, Foraminotomy or Discectomy, Lumbar, except for spondylolisthesis | 63005
63017 |
laminectomy of one or two vertebral segments laminectomy of more than 2 vertebral segments | |
| Laminectomy with removal of abnormal facets and/or pars inter- articularis with decompression, for spondylolisthesis, lumbar | 63012 | Gill-type procedure | |
| Laminotomy (hemilaminectomy), including partial facetectomy, foraminotomy and/or excision of herniated disc, lumbar | 63030
+63035 |
hemilaminectomy of one interspace hemilaminectomy of each additional interspace | |
| Laminotomy (hemilaminectomy), including partial facetectomy, foraminotomy and/or excision of herniated disc, re-exploration, lumbar | 63042
+63044 |
hemilaminectomy of one interspace hemilaminectomy of each additional interspace | |
| Laminectomy, facetectomy and foraminotomy, lumbar, (e.g., for spinal or lateral recess stenosis) | 63047
+63048 |
laminectomy of single vertebral segment laminectomy of each additional segment | |
| Note: Note: Codes 63030 and 60342 describe partial removal of the lamina (including partial removal of the facet and foramen) on
one side, with removal of intervertebral disc if performed. Bilateral modifier 50 can be used with these codes. Code 63047 describes complete removal of the lamina (including complete removal of the facet and foramen) on one or both sides, with removal of intervertebral disc if performed (CPT® Assistant December 2012). Bilateral modifier 50 cannot be used with this code. |
|||
| Discectomy, Lumbar | ||
| Procedure Description CPT ® Comments | ||
| Posterior Discectomy, Lumbar | 63030
+63035 |
discectomy of first interspace
discectomy of each additional interspace |
| Note: This procedure involves a laminectomy (hemilaminectomy) to access the disc. If the procedure is performed bilaterally,
use modifier 50. |
||
| Vertebroplasty | ||
| Procedure Description CPT ® Comments | ||
| Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance | 22510
22511 +22512 |
cervicothoracic lumbosacral
each additional level |
| Balloon Kyphoplasty | ||
| Procedure Description CPT ® Comments | ||
| Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation inclusive of all imaging guidance | 22513
22514 +22512 |
thoracic lumbar
each additional level |
| Cervical Arthroplasty (Total Cervical Disc Replacement, Artificial Disc ) | ||
| Procedure Description CPT ® Comments | ||
| Total Disc Arthroplasty, Anterior Approach, Cervical | 22856 | single interspace |
| Laminoplasty, Cervical | ||
| Procedure Description | CPT ® | Comments |
| Laminoplasty, Cervical with Decompression
Laminoplasty with Decompression and Reconstruction |
63050
63051 |
two or more vertebral segments two or more vertebral segments |