CERVICAL PROCEDURES PHYSICIAN CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) Procedure Description CPT Code Modifier Comments Anterior interbody fusion, with discectomy and decompression; cervical below C2 22551 first interspace 22552 each additional interspace Anterior Instrumentation 22845 2 – 3 vertebral segments 22846 4 – 7 vertebral segment 22847 8 or more vertebral segments Use of bone graft: Allograft (morselized) 20930 Add-on code Allograft (structural) 20931 Add-on code Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code Autograft (morselized, separate incision) 20937 Add-on code Autograft (structural, separate incision) 20938 Add-on code Note: Do not report 22554 or 22585 with 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. Cervical Arthroplasty Procedure Description CPT Code Modifier Comments Total Disc Arthroplasty, Anterior Approach, Cervical 22856 single interspace Laminoplasty Procedure Description CPT Code Modifier Comments Laminoplasty, Cervical 63050 two or more vertebral segments With Reconstruction 63051 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 pa- tient 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 866-946-0444.
Transcript
CERVICAL PROCEDURES PHYSICIAN CODING
Anterior Cervical Discectomy with Interbody Fusion (ACDF)
Procedure Description CPT Code Modifier Comments
Anterior interbody fusion, with discectomy and decompression; cervical below C2
Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code
Autograft (morselized, separate incision) 20937 Add-on code
Autograft (structural, separate incision) 20938 Add-on code
Note: Do not report 22554 or 22585 with 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.
Cervical Arthroplasty
Procedure Description CPT Code Modifier Comments
Total Disc Arthroplasty, Anterior Approach, Cervical 22856 single interspace Laminoplasty
Procedure Description CPT Code Modifier Comments
Laminoplasty, Cervical 63050 two or more vertebral segments
With Reconstruction 63051 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 pa-tient 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 866-946-0444.
CERVICAL PROCEDURES FACILITY CODING
Anterior Cervical Discectomy with Interbody Fusion (ACDF) with Anterior Plate Procedure Description ICD-9-CM Code Comments
Anterior column fusion, anterior approach, cervical (C2 level or below)
81.02
Discectomy 80.51
Insertion of interbody spinal fusion device 84.51
Fusion or refusion of 2-3 vertebrae (or) 81.62
Fusion or refusion of 4-8 vertebrae 81.63
Excision of bone for graft, other 77.79 harvested from the iliac crest or locally
Intra-operative monitoring 00.94
Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code 84.51. Allograft is included in the fusion code and not separately reported.
Cervical Arthroplasty
Procedure Description ICD-9-CM Code Comments
Cervical arthroplasty 84.62
Laminoplasty
Procedure Description ICD-9-CM Code Comments
Other exploration and decompression of spinal canal
03.09
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 sup-port 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 con-sequences of any actions taken in reliance on information in this document.
For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at 866-946-0444.
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LUMBAR PROCEDURES PHYSICIAN CODING
Anterior Lumbar Interbody Fusion (ALIF) with Posterior Instrumentation
Procedure Description CPT Code Modifier Comments
Anterior Interbody Fusion, Lumbar 22558 first interspace
22585 each additional interspace
Application of Biomechanical Device (cages, etc.) 22851 first interspace, if applicable
Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code
Autograft (morselized, separate incision) 20937 Add-on code
Autograft (structural, separate incision) 20938 Add-on code
Note: Codes 63030 and 63047 are bundled per the NCCI edits with code 22630. 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.)
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Laminectomy, Lumbar
Procedure Description CPT Code Modifier Comments
Laminectomy without facetectomy, foraminotomy or discectomy ,lumbar, except for spondylolisthesis
63005 one or two vertebral segments
63017 more than 2 vertebral segments
Laminectomy with removal of abnormal facets and/or pars interarticularis with decompression, for spondylolis-thesis, lumbar
63012 Gill-type procedure
Laminotomy (hemilaminectomy), including partial facetectomy, foraminotomy and/or excision of herniated disc, lumbar
63030 one interspace
63035 each additional interspace
Laminotomy (hemilaminectomy), including partial facetectomy, foraminotomy and/or excision of herniated disc, re-exploration, lumbar
63042 one interspace
63044 each additional interspace
Laminectomy, facetectomy and foraminotomy, lumbar 63047 single vertebral segment
63048 each additional segment PLIF/TLIF and Posterolateral Fusion (Single Incision 360°)
Procedure Description CPT Code Modifier Comments
Combined fusion, posterolateral fusion, with posterior interbody fusion
Application of Biomechanical Device (cages, etc.) 22851 first interspace, if applicable
22851 59 each additional interspace
Use of bone graft:
Allograft (morselized) 20930 Add-on code
Allograft (structural) 20931 Add-on code
Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code
Autograft (morselized, separate incision) 20937 Add-on code
Autograft (structural, separate incision) 20938 Add-on code
Note: Codes 63030 and 63047 are bundled per the NCCI edits with code 22630. 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).
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Direct Lateral Fusion with Anterior Instrumentation (DLIF)
Procedure Description CPT Code Modifier Comments
Anterior Interbody Fusion, Lumbar 22558 first interspace
22585 each additional interspace
Application of Biomechanical Device (cages, etc.) 22851 first interspace, if applicable
Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code
Autograft (morselized, separate incision) 20937 Add-on code
Autograft (structural, separate incision) 20938 Add-on code Percutaneous Vertebroplasty
Procedure Description CPT Code Modifier Comments
Percutaneous vertebroplasty, one vertebral body, unilateral, or bilateral injection
22520 thoracic
22521 lumbar
22522 each additional level
Note: Imaging guidance is reported separately when performed. Report code 72291-26 for fluoroscopic guidance or 72292-26 for CT guidance.
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Percutaneous Vertebral Augmentation
Procedure Description CPT Code Modifier 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 (e.g., kyphoplasty)
22523 thoracic
22524 lumbar
22525 each additional level
Note: Imaging guidance is reported separately when performed. Report code 72291-26 for fluoroscopic guidance or 72292-26 for CT guidance. Discectomy, Lumbar
Procedure Description CPT Code Modifier Comments
Posterior Discectomy, Lumbar 63030 first interspace
63035 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 pa-tient 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 866-946-0444.
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LUMBAR PROCEDURES FACILITY CODING
Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation
Excision of bone for graft, other 77.79 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 84.51. 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
Excision of bone for graft, other 77.79 harvested from the iliac crest or locally
Intra-operative monitoring 00.94Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code 84.51. Allograft is included in the fusion code and not separately reported.
Posterolateral Fusion with Posterior Instrumentation
Excision of bone for graft, other 77.79 harvested from the iliac crest or locally
Intra-operative monitoring 00.94
Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code 84.51. Allograft is included in the fusion code and not separately reported.
PLIF/TLIF and Posterolateral Fusion with Posterior Instrumentation (Single Incision 360°)
Excision of bone for graft, other 77.79 harvested from the iliac crest or locally
Intra-operative monitoring 00.94
Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code 84.51. Allograft is included in the fusion code and not separately reported.
Direct Lateral Interbody Fusion (DLIF) Procedure Description ICD-9-CM Code Comments
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 sup-port 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 con-sequences of any actions taken in reliance on information in this document.
For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at 866-946-0444.
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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 CCMS-DRG 455 Combined Anterior/Posterior Spinal Fusion without CC/MCC
Spinal FusionsOne or more of the following procedures:
81.02 Fusion, anterior column, other cervical, anterior technique
MS-DRG 456 Spinal Fusions Except Cervical with Spinal Curvature, Malignancy or 9+ Fusions with MCCMS-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:015.02 Tuberculosis of bones and joints, vertebral column, bacteriological or histological examination unknown (at present)
015.04 Tuberculosis of bones and joints, vertebral column, tubercle bacilli not found (In sputum) by microscopy, but found by bacterial culture
015.05 Tuberculosis of bones and joints, vertebral column, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically
170.2 Malignant neoplasm of vertebral column, excluding sacrum and coccyx
198.5 Secondary malignant neoplasm of bone and bone marrow
213.2 Benign neoplasm of bone and articular cartilage; vertebral column, excluding sacrum and coccyx
238.0 Neoplasm of uncertain behavior of other and unspecified sites and tissues; Bone and articular cartilage
239.2 Neoplasms of unspecified nature; bone, soft tissue, and skin
730.08 Acute osteomyelitis of other specified sites
730.18 Chronic osteomyelitis of other specified sites
730.28 Unspecified osteomyelitis of other specified sites
732.0 Juvenile osteochondrosis of spine
733.13 Pathologic fracture of vertebrae
737.0 Adolescent postural kyphosis
737.10 Kyphosis (acquired) (postural)
737.11 Kyphosis due to radiation
737.12 Kyphosis, postlaminectomy
737.19 Kyphosis (acquired), other
737.20 Lordosis (acquired) (postural)
737.21 Lordosis, postlaminectomy
737.22 Other postsurgical lordosis
737.29 Lordosis (acquired), other
737.30 Scoliosis [and kyphoscoliosis], idiopathic
737.31 Resolving infantile idiopathic scoliosis
737.32 Progressive infantile idiopathic scoliosis
737.33 Scoliosis due to radiation
737.34 Thoracogenic scoliosis
737.39 Other kyphoscoliosis and scoliosis
737.8 Other curvatures of spine
737.9 Unspecified curvature of spine
754.2 Congenital scoliosis
756.51 Osteogenesis imperfect
The secondary diagnoses that will lead to DRG 456, 457 or 458 assignment are:737.40 Curvature of spine, unspecified
737.41 Curvature of spine associated with other conditions, kyphosis
737.42 Curvature of spine associated with other conditions, lordosis
737.43 Curvature of spine associated with other conditions, scoliosis
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Procedure code:81.64 Fusion or refusion of 9 or more vertebrae
MS-DRG 459 Spinal Fusion Except Cervical with MCCMS-DRG 460 Spinal Fusion Except Cervical without MCC
Spinal FusionsInclude any of the following procedure codes:
MS-DRG 471 Cervical Spinal Fusion with MCCMS-DRG 472 Cervical Spinal Fusion with CCMS-DRG 473 Cervical Spinal Fusion without CC/MCC
Spinal FusionsInclude any of the following procedure codes:
81.01 Fusion, atlas-axis
81.02 Fusion, anterior column, other cervical, anterior technique
81.03 Fusion, posterior column, other cervical, posterior technique
Spinal RefusionsInclude any of the following procedure codes:
81.31 Refusion, atlas-axis
81.32 Refusion, anterior column, other cervical, anterior technique
81.33 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 en-counter is grouped to DRG 477, 478 or 479)
78.49 Other repair or plastic operations on bone
81.65 Percutaneous vertebroplasty
81.66 Percutaneous vertebral augmentation
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MS-DRG 490 Back and Neck Procedures except Spinal Fusion with CC/MCC or disc device/neurostimInclude any of the following procedure codes and procedure codes listed for MS-DRG 491:
84.59 Insertion of other spinal devices
84.62 Insertion of total spinal disc prosthesis, cervical
84.65 Insertion of total spinal disc prosthesis, lumbosacral
84.80 Insertion or replacement of interspinous process device(s)
84.82 Insertion or replacement of pedicle-based dynamic stabilization device(s)
84.84 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:03.02 Reopening, laminectomy site
03.09 Exploration and decompression, other spinal canal
03.1 Division, intraspinal nerve root
03.32 Biopsy, spinal cord or spinal meninges
03.39 Procedure, diagnostic other spinal cord and spinal cord structures
03.4 Excision or destruction, lesion, spinal cord or spinal meninges
03.53 Repair, vertebral fracture
03.59 Repair and plastic operation, other spinal cord structures
03.6 Lysis, adhesions, spinal cord and nerve root
03.93 Insertion or replacement, spinal neurostimulator
03.94 Removal, spinal neurostimulator
03.97 Revision, spinal thecal shunt
03.98 Removal, spinal thecal shunt
03.99 Operation, other, spinal cord and spinal canal structures
80.50 Excision or destruction, intervertebral disc, unspecified
80.51 Excision, intervertebral disc
80.53 Repair of the annulus fibrosus with graft or prosthesis
80.54 Other and unspecified repair of the annulus fibrosus
80.59 Destruction, other intervertebral disc
84.60 Insertion of spinal disc prosthesis, not otherwise specified
84.61 Insertion of partial spinal disc prosthesis, cervical
84.63 Insertion of spinal disc prosthesis, thoracic
84.64 Insertion of partial spinal disc prosthesis, lumbosacral
84.66 Revision or replacement of artificial spinal disc prosthesis, cervical
84.67 Revision or replacement of artificial spinal disc prosthesis, thoracic
84.68 Revision or replacement of artificial spinal disc prosthesis, lumbosacral
84.69 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 CCMS-DRG 517 Other Musculoskeletal System and Connective Tissue O.R. Procedure without CC/MCC
81.65 Percutaneous vertebroplasty
81.66 Percutaneous vertebral augmentation
84.81 Revision of interspinous process device(s)
84.83 Revision of pedicle-based dynamic stabilization device(s)
84.85 Revision of facet replacement device(s)
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MS-DRG 28 Spinal Procedures with MCCMS-DRG 29 Spinal Procedures with CC or spinal neurostimulatorsMS-DRG 30 Spinal Procedures without CC/MCC
03.0X Exploration and decompression, spinal canal structures
03.1 Division, intraspinal nerve root
03.2 Chordotomy
03.32 Biopsy, spinal cord or spinal meninges
03.39 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
03.99 Operation, other spinal cord and spinal canal structures
80.50 Excision or destruction, intervertebral disc, unspecified
80.51 Excision, intervertebral disc
80.53 Repair of the annulus fibrosus with graft or prosthesis
80.54 Other and unspecified repair of the annulus fibrosus
80.59 Destruction, other, intervertebral disc
81.0x Fusion, spinal
81.3x Revision, spinal
84.59 Insertion of other spinal devices
84.60 Insertion of spinal disc prosthesis, not otherwise specified
84.61 Insertion of partial spinal disc prosthesis, cervical
84.62 Insertion of total spinal disc prosthesis, cervical
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
84.66 Revision or replacement of artificial spinal disc prosthesis, cervical
84.67 Revision or replacement of artificial spinal disc prosthesis, thoracic
84.68 Revision or replacement of artificial spinal disc prosthesis, lumbosacral
84.69 Revision or replacement of artificial spinal disc prosthesis, not otherwise specified
84.80 Implantation of interspinous process decompression device(s)
84.82 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 sup-port 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 con-sequences of any actions taken in reliance on information in this document.
For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at 866-946-0444.
