June 11, 2015

Question:

I’m trying to figure out how to code a procedure for precertification. My neurosurgeon said she’s going to do a T10-S1 fusion. She’s doing a combined interbody and posterolateral fusion (22633) at L4-L5 and posterolateral fusions at all the other levels. Do I code 22610 for the thoracic fusion with modifier 59 along with 22633 (L4-L5, combined fusions) and 22614 x 6 units for the other levels?

Answer:

Not exactly, but good try! You’ll report only one stand-alone code (22633 for the L4-L5 combined fusions) and 22614 x 7 units for the additional levels of posterolateral fusion. It is not accurate to also report 22610. Don’t forget to report the other codes such as for the instrumentation and bone graft.