Orthopedic coding: Three tips to give wings to your PLIF claims
Orthopedic coding: Three tips to give wings to your PLIF claims
Remember to cash in on separately reportable bone grafts
When your orthopedist carries out posterior lumbar interbody fusion (PLIF), notes on instrumentation placement and other procedures carried out during the PLIF encounter are important. If you miss these separate services, you might lower your reimbursement.
But then, whether or not you can report laminectomy separately, depends on the extent of the surgeon's effort. Here's a quick primer on PLIF coding:
For additional interspaces, see + 22632
For a standard PLIF procedure, you should go for 22630. If the surgeon treats additional interspaces beyond the first, you should go for +22632.
For instance, the orthopedist carries outPLIF with diskectomy, using a structural iliac crest autograft for fusion at L4/L5 and L5/S1 interspaces. In this instance, you should go for 22630 (for the L4/L5 interspace) and 22632 (for the additional L5/S1 interspace).
Tips for reimbursement: Payers shouldn't apply a multiple-procedure reduction to the additional interspace code (+22632). According to CPT guidelines, add-on procedures are multiple-procedure exempt. Make it a point to review the explanation of benefits (EOB) to confirm that improper reductions weren't taken by the payer.
Different bone grafts, interbody devices and pedicle screws
If you are reporting arthrodesis (22630 and 22632) do not forget about the bone grafts that the surgeon places to stabilize the spine.
Normally, surgeons will either use an allograft (20931), which describes bone that comes from a bone bank or an autograft (20938) in which the bone comes from the patient's own body.
Concern about the separate site incision with risks of postoperative infection and pain have led many surgeons to choose structural allograft over autograft options.
Some surgeons also make use of an interbody prosthetic device (22851). This code does not apply to machine bone which should be reported as 20931.
22851 should be used once per interspace irrespective of the number of prosthetic devices placed within one interspace. If more than one interspace gets a prosthetic device, code 22851 may be reported again for each interspace added with the -59 modifier. With revision to code 22851, threaded bone allograft is now used with 20931 rather than 22851.
However, depending on circumstances, surgeons can opt any procedure from the 20930-20938 series for bone grafts.
Think about Standard' Laminectomy Part of Arthrodesis
Since laminectomy is a standard component of arthrodesis required to access and prepare the interspace for surgery, you shouldn't use regularly 63047 in addition to 22630/22632.
But then you may separately report arthrodesis and laminectomy in some circumstances. More precisely, the January 2001 CPT Assistant states that you should report 63045-63048 as proper when in addition to removing the disk and gearing up the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root , which requires work in excess of that normally carried out when doing a posterior lumbar interbody fusion (PLIF).
For more on this and for other specialty-specific articles to assist your orthopedic coding, sign up for a good medical coding resource like Coding Institute.
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