Coding & Reimbursement Q&A's

Find the answers to spine coding and reimbursement inquiries submitted to The Business of Spine by spine professionals in your arena. Check out the questions below and click the link to download the answers in PDF format:

 

Set 1: Q&A

  1. My surgeon will be performing a posterior fusion procedure in which he will be reducing and stabilizing a burst fracture at L1, screws at T12 and L2 with both autograft and allograft. What would be the coding for this type of procedure?
  2. Is the CPT code for getting the bone marrow aspirate (BMA) through the vertebral body the same as when you access this through the hip or pelvis?
  3. I run costs and verify all procedures prior to booking a case, and when I ran codes 20939 and 38215, they came up as non-payable codes for an ASC. Are these the proper codes to use for Bone Marrow Aspirate Concentrate (BMAC) procedures, or are there other codes that I should be using?
  4. We have been experiencing a notable uptick in denials for cases based on it being “experimental”. These denials started with Aetna and now we are seeing them from United as well. Can you please make sense of this?
  5. Is there a procedural code that I can use if bone marrow aspiration (BMA) is aspirated from the vertebral pedicles in an open lumbar case?
  6. What procedural code would I use for the added platelet rich plasma (PRP) application?
  7. How would you code a procedure as an ACDF?

Download the Answers to Set 1

 

Set 2: Q&A

  1. For a lumbar microdiscectomy where the surgeon used microsurgical and image guidance, which of the following would you expect to see coded; 0SB20ZZ for excision of lumbar vertebral disc, open approach or 0SB23ZZ for vertebral disc, percutaneous approach? Or would you expect a decent volume of both of these codes depending on the preferences of the facility/staff generating the claim?
  2. Should the term “percutaneous” only be applied if the operation is performed through a needle puncture in the skin? For example, if there is a ½ inch incision in the first step of the surgical technique – would this be considered “percutaneous”?
  3. What is the best way to incorporate the cost of implants for an ASC procedure?
  4. What HCPCS code would I use for a posterior lumbar cage?
  5. Is CPT code 63051 still a billable code for a laminoplasty if my surgeon performed a C2-C7 laminoplasty and reconstruction with mini-plates?
  6. What would the coding be for wide posterior cervical laminectomies with facectomies at C4-C5, C5-C6, C6-C7 and C7-T1 with instrumentation, lateral mass fusion and arthrodesis, with autograft and allograft? The patient’s diagnosis is cervical spondylosis with myelopathy, diagnosis code M47.12.
  7. If I'm performing a lumbar laminectomy, but it's for extradural lipomatosis, can I use CPT code 63267? What if it's at 3 levels; would I use that code 3 times?

Download the Answers to Set 2

 

Set 3: Q&A

  1. What revision code should be used in conjunction with CPT code 22853 if we have to go back in and reinsert a cage?
  2. What code would I use a decompression for lesion of the lumbar spine?
  3. Does the charge for the use of a PEEK cage increase if used at a facility?
  4. I have a client that is using allografts for ACDF’s however, I think a PEEK would be more appropriate. What would the coding be for a structural allograft compared to a PEEK implant for ACDF’s when using an independent plate?
  5. Are surgeons compensated more for putting two implants in the same disc space or in the same level?
  6. What is the difference in reimbursement between an interbody fixation system that incorporates the implant and the hardware, and an intervertebral body fusion device?
  7. If I perform a revision lumbar laminectomy from L4-S1, would I use CPT codes 63042 and 63044?

Download the Answers to Set 3

 

Set 4: Q&A

  1. Why is there a concern about not using an independent plate with my ACDF procedures?
  2. Why is Aetna denying CPT Code 20930 for the viable bone matrix?
  3. Does Medicare covered both in-patient and out-patient ACDF procedures?
  4. What is the difference in coding when using a PEEK cage instead of an allograft?
  5. What CPT code would you use if I was putting bone into a PEEK spacer?

Download the Answers to Set 4

 

Set 5: Q&A

  1. What is the difference in the surgeon’s payment using titanium implants compared to a structural allograft?
  2. What would the coding be for the placement of the amniotic membrane for anti-adhesion purposes?
  3. Why am I having issues getting reimbursed for ASC implants?
  4. What are the codes for harvesting bone marrow?
  5. What are the CPT codes for an ACDF with integrated spacer/plate?
  6. What is the CPT coding for a posterior lumbar fusion procedure; combined and lateral?

Download the Answers to Set 5

 

Set 6: Q&A

  1. What is the difference between MIS screws vs. open screws?
  2. What is the difference in pricing between an ACDF with PEEK and an ACDF without PEEK?
  3. How do you code for the different uses of a bone marrow aspiration concentration kit?
  4. Can you please clarify what type of procedure would include CPT code 62380 for endoscopic spine?
  5. What are the possible codes for lumbar microdiscectomy procedures?
  6. What would be the coding for an ALIF L3-L4, L4-L5 procedure?
  7. Would you use an allograft in a C5-6 posterior cervical fusion with instrumentation?

Download the Answers to Set 6

 

Set 7: Q&A

  1. What is the difference between implants, bone and coding for bone grafts?
  2. Why am I having issues getting reimbursed from Workers’ Comp for platelet-rich plasma (PRP) injection?
  3. What would be the coding/reimbursement for a surgeon using an interbody cervical cage with plate and screws at one level?
  4. What is the difference between ALIF coding and standalone coding?
  5. What reimbursement should my hospital expect for implants?

Download the Answers to Set 7

 

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