5 Essential Coding Tips for Spine Surgery in ASCs 

Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions

Watch the 2023 Anatomy of Coding Spinal Arthrodesis – Cervical and Lumbar Regions coding course on demand. Register here

As the director of coding education at nimble solutions, I’ve worked closely with ambulatory surgery center (ASC) coders on best practices for coding complex spine procedures, including the following ASC spine surgeries:

• Lumbar decompression for spinal stenosis 
• Anterior cervical discectomy and fusion 
• Lumbar posterior interbody fusion 
• Spinal cord stimulator 
• Radiofrequency ablation

In this blog post, I will delve into five essential coding tips that are specifically tailored to ASC spine surgeries. By implementing these strategies, ASC coders can navigate the intricacies of coding, maximize revenue, and contribute to the overall success of their surgical facility.  

These valuable coding insights will help you improve your coding accuracy and your ASC’s rate of collections. 

1. ASC spine surgery coders require correct documentation

There are several challenges to coding spine procedures, especially when multiple procedures were performed on one patient.  

Before beginning the coding process, it is crucial to have complete and accurate documentation to ensure you can assign the correct level of specificity for each procedure, including the correct modifiers. Claims are often denied because modifiers are not appended to the second or tertiary procedure. 

Be sure to obtain each patient’s operative notes, and implant logs. Carefully review the operative report to determine exactly how many nerve roots or levels were decompressed (63047 vs. 63052) and the exact number of levels that were fused.  If this is not clear in the operative report, you should query the physician. You can also review the transcribed operative notes as a team to avoid leaving any potential reimbursement opportunities on the table.

2. Code for add-ons when possible, but don’t unbundle 

Don’t miss opportunities to include add-on codes for ASC spine procedures. When coding for multiple level procedures, you’ll want to code the primary procedure first and use an add-on codes for the second and any additional levels.  

However, you should review each procedure code with CCI bundling edits and pay close attention to CPT guidelines. You don’t want to incorrectly unbundle CPT codes.  In general, when two services are performed at the same spinal level, you should not report the bundled procedure. 

3. Employ modifiers effectively

One of the most common ASC spine coding errors is the overuse of modifier –59.  

When the same service is performed at multiple spinal levels and requires the use of the same CPT code, it may be necessary to append modifier -59 on each duplicated CPT code: 

• Biomechanical devices are placed within the vertebral interspace at three different levels.   

• Report 22853 for the first device and 22853-59, 22853-59 for the additional devices to indicate these devices were placed at different levels.

Be sure to check operative notes and the CPT manual carefully before using additional codes and modifiers to ensure proper usage.

4. Understand the coded anatomy

A comprehensive understanding of spine anatomy is crucial for accurate coding, particularly with ICD-10 codes. Carefully review operative notes and documentation to make sure the diagnosis matches the spinal anatomy before assigning codes. 

One classic example of this is reporting a lumbar diagnosis for procedures at L1-L5 while reporting a lumbosacral diagnosis for procedures at L5-S1.  This will help you avoid inconsistencies that may lead to claim denials.  

Coders who stay updated on the latest regulatory billing and coding guidelines, as well as changes in payers’ individual medical policies, are more likely to see claims approved on the first submission.

5. Know what type of implant and/or graft was used

Spine surgeries have seen a shift from inpatient procedures to minimally invasive outpatient surgeries, and this trend is likely to continue. Knowing what types of grafts or implants the physician used for a spine fusion surgery is extremely important because each is reported with specific CPT codes.  
 
For example, CPT codes for spinal procedures will identify:  

• Whether the spacer made from titanium, PEEK (biomechanical device code) or structural bone (graft code). 
• If the surgeon used a standalone cage, as these include integrated hardware for anchoring the device. 
• If the implant has a separate plate and screws (these require additional CPT codes). 
• Whether the bone graft is an autograft or allograft, structural or morselized. 
• If the procedure is for a first-time implant, removal, or revision.  

It’s fairly common to see coding mix-ups with bone grafts. For example, one of the more common claim denial coding issues with musculoskeletal procedures is using CPT 20936 (autograph spine surgery local from same incision) instead of CPT 20930 (allograft for spine surgery only morselized).  

As technological advances and new techniques emerge, it is essential for ASC coders to stay updated on the latest developments in spine surgery to ensure accurate coding practices.

This blog post outlines some of the topics covered in the 2023 Spinal Arthrodesis – Cervical and Lumbar Regions coding course, available on demand with corresponding AAPC continuing education units included.