TLIF

Question:

I have an operative report where the neurosurgeon performed L5-S1 minimal invasive transforaminal lumbar interbody fusion (TLIF) with L5/S1 and an instrumented fusion (pedicle screws/rods). He did a far lateral transforaminal approach to disc space with left L5/S1 facetectomy and discectomy. He also placed a PEEK cage for the interbody arthrodesis packed with morselized allograft and autograft.

The surgeon gave the following codes: 63056, 63047, 22325, 22630, 22840, 22851, 20931 and 20936. Also, anytime we bill 22325 with 63047 the code gets denied. Is a modifier 59 appropriate on 22325? I’m not sure why 63047 always denies as inclusive. I’m also Question:ing code 63056 with 22630 – I’m not sure the two should be billed together. Can you help, please?

Answer:

Sure – there are a couple of issues here. First, you’re right – 63047 and 22325 should not be billed together for procedures performed at the same level. The fracture repair code (22325) includes removing bone fragments and decompression (63047). Do not append modifier 59 to 63047 when performed at the same spinal level as 22325. That said, your description of the procedure does not support reporting either code, 22325 OR 63047.

And, you’re right – 63056 should not be billed because it is part of the approach to perform the TLIF (22630). Finally, I think you’re confusing 20931 (structural allograft) with 20930 (morselized allograft). So the correct codes are, based on your description: 22630, 22840, 22851, 20930, 20936.

*This response is based on the best information available as of 04/09/15.