Surgery Center Coding Guidance: Anterior Cervical Diskectomy and Fusion Procedures
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The following article is written by Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting.
Fusions are also called arthrodesis procedures, which are performed for degenerative disc disease, herniated discs, disc injuries, spinal lesions and spinal stenosis. The surgeon removes disc material and cartilage in the area above and below the area where the fusion will be performed. There are many companion codes to these procedures, as detailed below. Cervical fusions are usually performed with an anterior approach and lumbar fusions are usually performed using a posterior approach.
In anterior cervical fusion procedures, the procedure is performed through an incision on the front of the neck just to the side, to avoid the trachea, esophagus and thyroid gland. There was a major change to the ACDF procedure for 2011. When anterior cervical fusions are performed, usually a discectomy is also performed. For dates of service in 2010 and before, two codes (63075 for the discectomy and 22554 for the fusion) were required. For 2011, CPT combined these two procedures into one new code. Use code 22551 for the 1st level of fusion and discectomy performed and add-on code 22552 for subsequent levels. Codes 63075 and 22554 are still valid for use in cases where only those individual procedures are performed and they are not combined.
Code 22554 is for an arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression); cervical below C2 performed without a discectomy procedure.
Use code 63075 for an anterior discectomy procedure with a decompression of the spinal cord and/or nerve root(s), including osteophytectomy; performed on a single cervical interspace performed without a fusion procedure.
In most cases, ACDFs are performed with both fusion and discectomy procedures. The dura and/or neural elements are exposed to ensure decompression, which is considered over and above the work described by the cervical fusion alone. The procedure includes drilling off the posterior osteophytes, opening the posterior longitudinal ligament to look for free disk fragments (decompressing the spinal cord) or removing far lateral disk fragments to decompress the nerve roots. The usual ACDF procedure will include use of anterior instrumentation — code 22845 for 2-3 segments or 22846 for 4-7 segments.
When the discs upon which the surgery is performed are listed in the operative report as C4-5, C5-6 and C6-7, the 22846 code for instrumentation at 4 vertebral segments would be billed (whereas, only a fusion at 3 levels would be billed). Other typical charges would include the graft, imaging and code L8699 for the use of any allografts and instrumentation used in the procedure. An example of coding for this procedure performed at a single level C6-7 using a cage and a morcellized autograft harvested from the iliac crest would be:
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