Q: Can we code 20930 for iFactor bone graft used with interbody device?
A: Yes, it’s appropriate to report any separate grafting material used with an interbody device.
Q: Can we code 63042 for revision decompression with no discectomy?
A: No, a discectomy is required to report 63042. You would select either 63001-630017 or 63045-63048 depending on elements removed during decompression.
Q: Do you happen to know if laminectomy procedures like 63047 if they can be charged out with lumbar spinal fusions. It seems they are often denied when reported with lumbar spinal fusions. It just is confusing because the lumbar fusion codes do not include the decompression part of the procedure.
A: This is probably the biggest controversy in CPT spinal fusion coding. First of all, CPT 63047 does not bundle with 22612, so that’s an easy yes, you can bill both. The issue is that CPT 63047 bundles with both 22630, 22633. However, it’s important to note that the code descriptions for both 22630 and 22633 state “other than for decompression”. So, it is defendable to report a full decompression separately when there is good documentation and indication. Also, CPT Assistant May 2018, Volume 28 states the following:
“In the Frequently Asked Questions (FAQ) section (page 11) of the October 2016 issue of CPT® Assistant, the Surgery: Nervous System answer incorrectly stated that codes 22633, Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/ or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar, and 63047, Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar, may not be reported for the same interspace. On further analysis of this issue, it was demonstrated that this recommendation was inconsistent with previously published CPT® Assistant advice, which is that codes 22633 and 63047 may be reported for the same interspace when additional work is required to complete a decompression at a single spinal level. It is also appropriate to report codes 22633 and 63047, if the two procedures are performed at different interspaces. Modifier 59, Distinct Procedural Service, should then be appended to indicate that these are two distinct procedures.”
***Of course, this does not guarantee payment and payor policies should be reviewed.
Deanna Upston, CPMA, CPC, COSC
Consultant
Deanna is a consultant for The Haugen Consulting Group with over 20 years of health care industry experience. Her introduction was through medical assisting, which she enjoyed for several years. Once she was established at a surgeon’s office, she started coding their surgical cases and discovered that was her favorite part of the day. Deanna has experience working on the professional fee side of coding, audit, education and compliance serving coders and physicians. She has put together multiple education sessions for both provider and coder. She also has experience working as an analyst in which she validated the integrity of editing logic during the implementation of claim scrubbing software.