Post-operative cases of scoliosis will need to be accompanied by the proper diagnosis code for the scoliosis (M41.12 for adolescent idiopathic scoliosis, for example), as well as the code Z98.1 (arthrodesis status).
An ambulatory, five year old girl with syndromic scoliosis which has progressed to 90 degrees and includes significant pelvic obliquity undergoes growing rod instrumentation from T4 to the pelvis. Pedicle screws are placed bilaterally at T4 and T5 as well as at L5 and S1 along with bilateral iliac screws.
For this procedure the base code is 22802 arthrodesis posterior for spinal deformity as it has the highest RVU value. 22633 arthrodesis posterior interbody technique and 22212 osteotomy of spine are also a base code (a 90 day global code) but have lower RVU and therefore listed as an additional procedures with Modifer 51 (multiple procedures.)
Coding for Growing Rod Surgery. 22800 - Arthrodesis, posterior, for spinal deformity, up to 6 vertebral segments 22844 - Posterior segmental instrumentation (e.g., pedicle fixation, dual rods); 13 or more vertebral segments 22848 - Pelvic fixation (attachment of caudal end of instrumentation to pelvic...
22800 (deformity arthrodesis) would be the appropriate code in this case as the primary diagnosis is a spinal deformity (scoliosis.)
Fusion of spine, site unspecified M43. 20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM M43. 20 became effective on October 1, 2021.
Interbody fusion devices (A)—examples include: interbody fusion cages, BAK cages, PEEK cages, bone dowels. Autologous Tissue Substitute (7)—bone graft obtained from the patient during the procedure.
Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Anterior Approach, Anterior Column, Open Approach. ICD-10-PCS 0SG00A0 is a specific/billable code that can be used to indicate a procedure.
ICD-10-CM Code for Scoliosis, unspecified M41. 9.
Fusion of spine, lumbar region The 2022 edition of ICD-10-CM M43. 26 became effective on October 1, 2021. This is the American ICD-10-CM version of M43.
A spinal fixation device stabilizes an area of the posterior spine while allowing for a significant range of motion and limiting the compression of the affected vertebrae. The device consists of two or more arm assemblies (lateral) connected by one or more telescopic assemblies (vertical).
share pin it Newsletters. By Stephen P. Montgomery, MD. Spinal fusion (such as a TLIF) is a surgical technique to stabilize the spinal vertebra and the disc or shock absorber between the vertebra.
In the PLF group, all patients had iliac crest bone graft. In the PLIF group the source of the bone graft is laminar and spinous process.
Alteration is defined as modifying the natural anatomic structure of a body part without affecting the function of the body part. The principal purpose is to improve appearance. Alteration is coded for all procedures performed solely to improve appearance.
If the fusion was performed at L1-L3, then the body part value that is assigned is “1-Lumbar vertebral joint, 2 or more,” meaning two joints.
360-degree lumbar fusion is also known as an Anterior/Posterior Lumbar fusion. The procedure is an extremely common method for fusing the lumbar spine in which there is an incision anterior in the abdominal area and incisions posterior in the lumbar or low back region.
Code +22853 is an add–on code and must be reported with an appropriate primary procedure, such as 22548–22586 (Anterior or anterolateral approach technique arthrodesis procedures on the spine [vertebral column]), but there are many other codes that can be reported as a primary code.
ICD-10 code M43. 22 for Fusion of spine, cervical region is a medical classification as listed by WHO under the range - Dorsopathies .
Arthrodesis refers to the fusion of two or more bones in a joint. In this process, the diseased cartilage is removed, the bone ends are cut off, and the two bone ends are fused into one solid bone with metal internal fixation.
Bone or joint fusion surgery, called arthrodesis, is performed to relieve arthritis pain in the ankles, wrists, fingers, thumbs, or spine. In arthrodesis, two bones on each end of a joint are fused, eliminating the joint itself and making one continuous bone. This surgery is typically quite successful.
The implementation of ICD-10-PCS has enhanced the skills of coding professionals as it contains many unique features that provide an opportunity to accurately reflect the complexity of the procedures being performed. The assignment of ICD-9-CM procedure codes for spinal fusions often challenged coding professionals, and this has not changed with the transition to ICD-10-PCS. As with the coding of other complex surgical procedures, coding professionals struggle with identifying which portion of the spinal fusion procedure to code or not to code.
The code for this procedure is 0QB20ZZ, with the body part character (fourth character) being 2 for right pelvic bone. The iliac crest does not have its own distinct body part value in ICD-10-PCS, with the ICD-10-PCS Body Part Key indicating that the pelvic bone is the closest proximal branch.
The codes for the anterior spinal fusion are 0SG00AJ (L4-L5) and 0SG30AJ (L5-S1) . Two codes are also assigned for the posterior spinal fusion, 0SG0071 (L4-L5) and 0SG3071 (L5-S1) . Codes 0SB20ZZ and 0SB40ZZ are also assigned for the discectomy performed at two different levels of the spine. Lastly, code 0QB20ZZ is assigned for the harvesting of the right iliac crest bone graft.
If an interbody fusion device is used (alone or containing other material like bone graft), the procedure is coded with the device value Interbody Fusion Device (A)
If a mixture of autologous and nonautologous bone graft (with or without biological or synthetic extenders or binders) is used, the procedure is coded with device value Autologous Tissue Substitute (7)
If the operative report documents that a discectomy is performed , the correct root operation is Excision. However, if the operative report documents a “total discectomy,” the root operation is Resection.
Qualifier: The qualifier character identifies the column of the spine being fused (anterior or posterior) and if the surgical approach is from the front or back of the body (see Figure 1 below).
1. 7-year-old male with early onset scoliosis is treated with growing rod instrumentation that spans from T3-L4. The procedure entails use of pedicle screws with associated fusions at the cranial (T3-4) and caudal terminus (L3-4) of the construct, and use of morselized allograft at the T3-4 and L3-4 fusion sites. Two possible coding scenarios could be considered. The first scenario is most accurate as the deformity fusion codes best match the primary (deformity) diagnosis.
Removal of broken rods and reinsertion of new rods= reinsertion of spinal fixation/instrumentation
Since fusion and instrumentation is extended to a new level, use the appropriate instrumentation codes 22840-22848. Depending on the details of the procedure and accompanying documentation non segmental instrumentation (22840) and segmental instrumentation (22842) are possibilities.
This procedure utilizes code 22802/22843 as a T4-L1 fusion involves 10 vertebra. The -51 modifier for multiple procedures is not necessary in this case as 22843, 20936, and 20930 are considered add-on codes, and therefore modifier exempt
arthrodesis, posterior, for spinal deformity with or without cast; up to 6 vertebral segments
The Coding Committee has been asked to provide the membership with advice and examples to help understand the complexity of coding and reimbursement issues specific to spine and spinal deformity surgeons. Every effort has been made to be accurate and adhere to the ICD-9 coding conventions and guidelines as well as the CPT rules. However there may be unintended discrepancies or differences of opinion. With that in mind, these coding scenarios are not intended to provide legal advice to surgeons and their staffs. The information given by the committee should not be relied upon as an official interpretation of the AMA CPT® code book. The American Medical Association (AMA) is the only entity which can give an official and binding interpretation of the AMA CPT® code book, and should be contacted directly if an official comment is needed or desired. For more information contact the AMA CPT® Network at www.cptnetwork.com.
This a difficult coding scenario. Multiple codes are available for coding for a scoliosis cast, however no consensus exists for this procedure.
The Coding Committee has been asked to provide the membership with advice and examples to help understand the complexity of coding and reimbursement issues specific to spine and spinal deformity surgeons. Every effort has been made to be accurate and adhere to the ICD-9 coding conventions and guidelines as well as the CPT rules. However there may be unintended discrepancies or differences of opinion. With that in mind, these articles are not intended to provide legal advice to surgeons and their staffs. The information given by the committee should not be relied upon as an official interpretation of the AMA CPT® code book. The American Medical Association (AMA) is the only entity which can give an official and binding interpretation of the AMA CPT® code book, and should be contacted directly if an official comment is needed or desired. For more information contact the AMA CPT® Network at www.cptnetwork.com. It is our every intention that the articles we prepare for this year’s newsletters are helpful and useful to all members of the SRS and their staffs. - Jeffrey B. Neustadt, MD, Chairman, Coding Committee
20930 - Allograft for spine surgery only; morselized
Growing rod surgery does not have specific or accurate CPT codes assigned. The initial surgery includes segmental instrumentation, limited fusions, as well as bone grafts. Lengthening surgery may or may not include a revision to the instrumentation.
Post-operative cases of scoliosis will need to be accompanied by the proper diagnosis code for the scoliosis (M41.12 for adolescent idiopathic scoliosis, for example), as well as the code Z98.1 (arthrodesis status). This code is grouped within the Diagnostic Related Group (DRG) as a factor influencing health status, and can be used to indicate a variety of types of surgically-induced fusions (as opposed to congenital).
The code M41 for scoliosis includes kyphoscoliosis (lateral curvature of the spine accompanied by hyperkyphosis of the thoracic spine), but excludes cases of scoliosis caused by bony malformations (congenital), as well as cases of scoliosis which arose as a consequence of surgery or other procedures (post-procedural).
Adolescent idiopathic scoliosis (M41.12), commonly abbreviated AIS, is diagnosed after the age of 10 in a skeletally-immature patient (typically up to 17 years of age). It is often quoted that AIS comprises 80% of all scoliosis cases; one should keep in mind that school scoliosis screenings are typically conducted on adolescents, and that we generally stop looking after that. Although the incidence of scoliosis in adolescents is reported to be between 2% to 4.5%, when adults are examined for signs of scoliosis, the incidence has been reported at 12%, 20%, or even 66%. Screening may miss many mild cases of scoliosis, or scoliosis could be developing after the screenings; in either case, this illustrates the importance of screening for scoliosis in all of your patients – not just adolescents. When conducting scoliosis screenings, be sure to use a scoliometer; this device significantly improves the effectiveness of the examination.
Juvenile idiopathic scoliosis (M41.11) is diagnosed from 3 to 9 years of age. Between the ages of 3 to 6 is considered early-onset juvenile scoliosis; 7 to 9 is considered late-onset juvenile scoliosis; the prognosis is poorer in younger patients, as scoliosis progresses at a higher rate when the patient has growth potential remaining.
It is more common in males than in females. Many cases of idiopathic infantile scoliosis tend to spontaneously resolve within a few years ; however, those that do not stand a great risk of progressing to severe levels later in life.
This includes cases of degenerative (or de novo) scoliosis, which tend to arise in the lumbar spine in individuals past the age of 40 as a consequence of intervertebral disc degeneration and a loss of integrity of the annulus fibrosus. Degenerative scoliosis is often accompanied by lateral listhesis (sideways slippage) of the apical vertebra (e), ...
Thoracogenic scoliosis (M41.3) is not a very commonly used code; however, when it is used, it is often used incorrectly. Literally interpreted, “thoracogenic” means, “arising in the thoracic spine.” Thus, one might incorrectly use this code for a case of scoliosis which began in the thoracic spine. However, the Scoliosis Research Society defines thoracogenic scoliosis as, “spinal curvature attributable to disease or operative trauma in or on the thoracic cage.” In reality, this code should only be used when the patient has a case of scoliosis that arose either as a consequence of an operation (such as a thoracotomy or thoracoplasty), or due to a non-neuromuscular disease process, such as a lymphoma.
The 2022 edition of ICD-10-CM M41.9 became effective on October 1, 2021.
Appreciable lateral deviation in the normally straight vertical line of the spine. Scoliosis causes a sideways curve of your backbone, or spine. These curves are often s- or c-shaped. Scoliosis is most common in late childhood and the early teens, when children grow fast.