Physician > Frequently Asked Questions

Topics:
Coding
INFUSE® Bone Graft
MAST™
360° Spinal Fusions

1. Where can the Physician Fee Schedule be found?

   The Physician Fee Schedule can be found on the CMS website: http://cms.hhs.gov/physicianfeesched

2. What type of reference material is available to determine how a modifier will effect payment when used with a certain CPT code?

   The Medicare Physician Fee Schedule Database (MPFSD) is published by CMS and updated annually. MPFSD has a list of indicators that reflect how claims are processed. All CPT/HCPCS codes subject to MPFSD indicators are provided in this database. The indicators will show whether or not a specific modifier can be used with a certain code and how the modifier will effect reimbursement. MPFSD also contains information regarding the appropriateness of billing for a co-surgeon for certain CPT/HCPCS codes. The MPFSD can be accessed at http://www.cms.hhs.gov/physicianfeesched.

1. Does Medtronic Sofamor Danek offer any courses on coding for spinal procedures?

   Yes. It's no longer necessary to travel to a classroom in order to stay abreast of changes in the industry. Now it's possible to go online and learn about the latest developments in the business of spine care, coding changes, regulations, and documentation requirements because Healthcare Economic Services (HES) provides live interactive programs free of charge throughout the year.

   Through live WebEx programming, you can:

   • Ask questions and receive answers in real time
   • Get a basic overview of spine anatomy, spinal instrumentation and surgical procedures
   • View actual techniques, medical device instrumentation and procedures for spine surgery
   • Clarify the correct use of modifiers in complex spine surgery coding
   • Clarify the correct use of CCI edits in complex spine surgery coding
   • Identify new technologies and common documentation challenges
   • Learn spinal CPT and ICD-9 coding through working with case examples
   • Understand the pros and cons of the development of a spine center
   • Gain knowledge about negotiating managed care contracts for your hospital
   • Gain knowledge about negotiating managed care contracts for your physician practice

   Contact HES at (800) 876-3133 to obtain a schedule of upcoming courses.

2. What is the appropriate code for reporting CORNERSTONE®, TANGENT®, PRECISION-GRAFT™ and other tricortical allografts?

   Per the February 2005 edition of CPT Assistant, all structural allograft bone used for spine surgery should be coded as 20931. The only exception is for threaded allograft bone dowels as they should be coded 22851. In addition, code 22851 is also appropriate for intervertebral devices made of PEEK or metal.

3. How many times per encounter can an allograft for spine surgery be reported?

   Medicare guidelines state an allograft for spine surgery can only be reported once per operative session regardless of the spinal levels to which the allograft is placed.

4. How do you code percutaneous vertebroplasty?

   CPT codes 22520 - 22522 are appropriate based level of spine.

5. How should a percutaneous vertebroplasty procedure be coded when performed at multiple levels?

   CPT codes 22520 "thoracic" and 22521 "lumbar" are reported for single level vertebroplasties, unilateral or bilateral.  If performed on additional thoracic or lumbar bodies during the same operative episode, add-on code 22522 should be used as an additional code for the respective vertebral body.  For example, if a vertebroplasty is performed at T12, L1, L2, and L3, codes 22520 (T12), 22521 (L1), 22522 (L2), and 22522 (L3) should be reported.

6. How do you code the procedure Kyphoplasty?

   Refer to codes 22523-22525

   22523	Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg. Kyphoplasty); thoracic
   22524	lumbar
   22525	each additional thoracic or lumbar vertebral body

   Kyphoplasty is a percutaneous augmentation procedure that uses a mechanical device to create a cavity within the vertebral body.  This differs from a vertebroplasty because the vertebroplasty procedure does not utilize the mechanical device (i.e. miniature expandable jacks, curved tamps, expandable balloon tamps, etc.) for cavity creation.

7. How are procedures titled "laminoplasty" coded?

   CPT code 63050 or 63051 is appropriate depending on whether there is reconstruction of the posterior bone elements.

8. Should codes 22630 and 63047 be reported together?

   Yes, if the laminectomy is performed for decompression. This is per the AMA CPT guidelines.

9. What code should the exposure surgeon report when performing the exposure for a spinal fusion?

   The opening and closing of a procedure is considered an inherent part of the procedure. The approach surgeon along with the primary surgeon would bill the primary procedure code, the fusion, and append a modifier 62.

10. I've heard that there are new codes to report the placement of an artificial disc. What are the codes and what are their corresponding Relative-value Units (RVUs)?

    The codes for disc arthroplasty are in a separate section of CPT, entitled Category III codes, used to identify emerging technology, services, and procedures for clinical efficacy, utilization and outcomes. Because of this, many payers view these codes as representing experimental/investigational procedures and are reluctant to reimburse for the codes.

    There are no Relative-Value Units (RVUs) assigned for Category III codes, meaning that payment for the codes have not been established. It will be up to the discretion of the payer (including Medicare) to determine if and what amount they are willing to pay the surgeon for the procedure. Use of Category III codes requires the surgeon to submit a paper claim along with an operative report describing the procedure in order to justify the surgeon's fee.

    Codes for the placement or revision of artificial discs are as follows:

    • 0090T - Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace; cervical
    • 0091T - Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace; lumbar
    • 0092T - each additional interspace
    • 0093T - Removal of total disc arthroplasty, anterior approach, single interspace; cervical
    • 0094T - Removal of total disc arthroplasty, anterior approach, single interspace; lumbar
    • 0095T - each additional interspace
    • 0096T - Revision of total disc arthroplasty, anterior approach, single interspace; cervical
    • 0097T - Revision of total disc arthroplasty, anterior approach, single interspace; lumbar
    • 0098T - each additional interspace

1. Is there a CPT code for INFUSE® Bone Graft?

   There is not a separate CPT code for the preparation or implantation of INFUSE® Bone Graft. The surgeon should code the mechanism by which INFUSE® Bone Graft is implanted (i.e., 22851 for insertion of the cages containing INFUSE® Bone Graft).

2. What codes are to be assigned by the physician when coding for a fusion using INFUSE® Bone Graft?

   Generally, there are two codes used by the physician when performing a fusion using INFUSE® Bone Graft. Using the FDA approved use of INFUSE® Bone Graft as an example (ALIF with an LT-CAGE® device), the physician's services would be coded as follows:

   CPT Code	Description
   22558	Anterior Interbody Fusion
   22851	Cage Application

   
   It is important to note that any coding questions should always be directed to our Physician/Hospital Coding Support Line, SPINELINE™ at 1-877-690-5353.  It is staffed by certified coders who understand the intricacies of the codes and how variations in procedures can affect the code(s) that need to be assigned.

1. How is the METRx™ procedure coded?

   CPT code 63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar (including open or endoscopically assisted approach) should be used for the outpatient setting. 63035 would be assigned in addition to the primary procedure for each additional interspace. 63020 would be assigned for cervical level procedures.

1. There seems to be lots of confusion regarding 360° fusions. Would you please clarify the clinical components that constitute a 360° spinal fusion?

   Clinically, a 360o spinal fusion is an anterior and posterior fusion of a vertebra performed during the same operative session.  There are two ways to accomplish a 360o fusion.  In the conventional one, an incision is made in the patient's front (abdominal region) to do the anterior fusion, then the patient is flipped over and a second incision is made in the back to do the posterior fusion.  The second method is a single incision approach, where both the anterior and posterior faces of the vertebra are reached through one incision.  Depending on the patient's clinical situation, this single incision can be either posterior or transforaminal but not anterior.
   
   A 360° spinal fusion requires that both the front and back of the vertebra be fused.  Fusion is a "welding" process by which two or more vertebrae are fused together with bone grafts, a bone equivalent, or a bone substitute into a single solid bone.  In a 360o fusion, bone or bone substitutes are placed between the vertebrae to promote the anterior fusion.  Then for the posterior fusion, bone is laid along the transverse processes of the vertebrae; this is sometimes called laying bone "in the gutters".  Alternately, some surgeons accomplish the posterior fusion by "roughing up" the facets and then laying the resulting bone chips posteriorly.
   
   Spinal instrumentation, like screws and rods and plates, is almost always used posteriorly as well.  Just note that the instrumentation is used for fixation and stability, not fusion per se.  Regardless of the instrumentation, it's the use of bone grafts or chips, a bone equivalent, or a bone substitute that actually constitutes the fusion.  For a 360o fusion, these bone devices must be used both front and back, with or without instrumentation.

The material presented in these FAQs is provided to our customers to assist them in obtaining correct and appropriate coverage and reimbursement for healthcare goods and services. To the best of our knowledge, the information contained within was correct as of the date of publication. However, there can be no assurances that it will not become outdated, without notice from Medtronic Sofamor Danek, or that the government or other payers may not differ with the guidance contained in the FAQs. The responsibility for correct coding, reimbursement submissions, and following device labeling lies with the healthcare provider. We urge you to consult with your coding advisors to resolve any billing questions that you might have.

Current Procedural Terminology (CPT) is copyright 2005 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

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