Frequently Asked Questions

NASS provides Answers to its members' inquiries regarding CPT coding as an educational service to its members. While the answers express the interpretation of the CPT Code Book by the members of the Coding and Nomenclature Committee, in response to a specific fact situation presented, the Committee's answers are the opinions of the Committee members only, and do not reflect an official position or statement by NASS. The answers given by the Committee should not be relied upon as official interpretations of the CPT code book. The American Medical Association is the only entity which can give an official and binding interpretation of the CPT Code Book, and should be contacted directly if an official comment is needed or desired. The department to contact at the AMA is the CPT Information Services at 1-800-634-6922. The AMA will provide guidance on a fee for service basis.

Additional coding information may be attained at one of NASS' coding courses offered throughout the year. For more information, contact the NASS Education Department at (630) 230-3600 or ask a coding question here.

The Common Coding Scenario for comprehensive Spine Care Publication contains key components of procedure documentation and coding according to AMA CPT Guidelines for spine procedures, injections and radiologic techniques. For more information or to obtain a copy, contact the NASS Member Service Department or visit the NASS Store.

Co-Surgeon / Approaches

How would you code an anterior spinal fusion of L5-S1 with cages and bone grafting if performed by a spinal surgeon and general surgeon? (NASSNews, Volume X11, Number 1)

When two surgeons work together as co-surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report their distinct operative work by adding the modifier '-62' to a SINGLE definitive procedure. That is, each surgeon should report the co-surgery once using the same procedure code. If additional procedure (s) (including add-on procedure(s)) are performed during the same surgical session, separate code(s) may be reported without the modifier '-62'.

Note: If a co-surgeon acts as an assistant in the performance of an additional procedure(s) during the same surgical session those services may be reported using separate procedure code(s) with a modifier '-80' or modifier '-81' added, as appropriate.

In this example: For an anterior spinal fusion of L5-S1 with cages and bone grafting, a spinal surgeon and a general surgeon working together would be coded as follows: 

If the general surgeon assists the spinal surgeon for the entire case, how would the coding change? (NASSNews, Volume X11, Number 1)

If the general surgeon assists the spinal surgeon the entire case, it would be coded as follows:

How do you code for the anterior approach when the same surgeon performs the approach as well as the fusion? (NASSNews, Volume X11, Number III)

The way you code when the spine surgeon does the approach as well as the definitive procedure is to only code the definitive procedure. It is inappropriate to use the retroperitoneal exploration codes because if only one surgeon is doing the procedure, the incision and closure of the incision is included in the definitive procedure in the spine code section of CPT.

Arthrodesis

How would you code a fusion of L1 to L3? What are the appropriate procedure codes? Is it 22612, 22614, 22614 - three vertebral segments or are 22612, 22614 - 2 actual fusions - L1-L2, L2-L3?

Proper coding of the above operative procedure pending the physician work is clearly stated in the operative note is 22612 and 22614 (L1-2, L2-3). Arthrodesis implies a fusion of a motion segment. A vertebral segment refers to two adjacent vertebra, and its intercalary disc; therefore, you should use 22614 only once.

Exploration


In the "Common Coding Scenarios" book, you list 22830 - Exploration of Spinal Fusion as billable separately from 22612 - Arthrodesis. However, in the Correct Coding Initiative, the exploration is bundled into the arthrodesis code. Is it fraudulent to bill separately? (April 2000 NASS Coding Report)

There are two parts to this answer. First, AMA CPT guidelines allow for exploration of spinal fusion to be coded with the removal of instrumentation and/or arthrodesis. However, HCFA has indicated through its reimbursement rules/Correct Coding Initiative (CCI) that 22830 is bundled with 22612; therefore, only one code will be reimbursed. Please note AMA CPT guidelines DO NOT dictate reimbursement rules/regulations, HCFA does.

Instrumentation


How do you code for additional cages? Do you use it as two units or use a -51 modifier? (NASSNews, Volume X11I, Number III)

22851 is used only once per interspace and is independent of the number of devices placed. Since 22851 is an add-on code, you do not append a -51 modifier.

Can a surgeon code 22851 for an application of a threaded bone dowel? (NASSNews, Volume X11I, Number 1II)

Yes, threaded bone dowels are coded as 22851. The same rules apply, if you use two bone dowels at one interspace, the code is used only once. If you use one dowel at each of two interspaces, then the code may be used twice. The recent editorial change to the code allowed the application of 22851 to threaded dowels since they are more prosthesis than bone graft.

Posterior Lumber Interbody Fusion


One surgeon performs a posterior interbody fusion with a BAK prothesis. Can you bill 22630, 63047 and 22851? (NASSNews, Volume X11, Number II)

When performing a posterior lumbar interbody fusion (PLIF) and anterior cage instrumentation you can code for posterior lumbar arthrodesis interbody (22630), and anterior instrumentation (add-on code 22851); and bone graft (20937) if performed, but not for a laminectomy. This is because the laminectomy was included in the PLIF procedure vignette in the RUC survey used in determining the physician work (WRVU) value.

This is a common question and to better understand why these codes are currently bundled, an explanation of the Relative Value Update Committee (RUC) process is helpful. This process determines the value of specific CPT codes.

When a new code is introduced through the CPT process a RUC survey is completed by the specialty societies to assist in making the new code reimbursement recommendation. This survey includes a vignette of the physician work involved in the procedure and requires physicians to determine the amount of physician work involved in the procedure. The result of this survey is the basis for proposing a relative value unit or reimbursement amount to the code.

What does this have to do with bundling of codes? Whatever procedures are included in the RUC survey vignette for a given CPT code is considered bundled or part of the procedure.

When the AMA created the vignette for a PLIF (22630) it included laminectomy (63047) as being included in the PLIF procedure. Therefore, the surgeons who completed the RUC survey were asked to include the laminectomy in determining the amount of physician work required to perform the PLIF procedure.

This is why the AMA CPT rules do not allow for the coding of 63047 and 22630 and the Correct Coding Initiative Edits (CCI Edits) and the AAOS global Services book reflect these codes bundled.