2014
`
`Reimbursement Guide
`
`63057
`
`63055
`
`63075
`
`6307722841228416303522841630772284163077
`
`
`
`63064630576306463057
`
`22851
`63045
`22558
`630562284563056
`
`
`
`
`225532255322556225532255622553225532261222612
`
`
`20936
`
`
`63048 2093022612630482261263048
`20930630052093063005
`
`
`63064
`61783
`20840
`
`
`630576305720936209366305720936
`
`2255422554225542255122551
`
`61783
`
`
`20930
`2285120937
`
`2093720937
`
`22551
`63090
`
`6307663076
`63047
`63090
`22595
`20840
`38220
`22614
`
`6305563055
`
`6300163001
`
`
`630426304263042
`
`63035
`
`2284522845
`
`
`
`6304663046
`
`

`

`
`
`20142014
`
`
`
`Reimbursement GuideReimbursement Guide
`
`

`

`CONTENTS
` I. Introduction
` II. Physician Coding and Payment
`
`1. Fusion Facilitating Technologies
`
`2. NVM5 ® Intraoperative Monitoring System
`III. Hospital Inpatient Coding and Payment
`
`1. NuVasive ® Technology
`
`2. Non-Medicare Reimbursement
`I V. Outpatient Facility Coding and Payment
`
`1. Hospital Outpatient
`
`2. Non-Medicare Reimbursement
`
`3. Ambulatory Surgery Center
`
`4. Facility Device and Implant Codes
` V. Coding and Payment Scenarios
`
`1. Cervical Anterior Scenarios
`
`2. Cervical Posterior Scenarios
`
`3. Thoracolumbar Anterior Scenarios
`
`4. Lumbar Combined Anterior-Posterior Scenarios
`
`5. Lumbar Posterior-Posterolateral Scenarios
` VI. Technology Overview
`
`1. Cervical
`
`2. Thoracolumbar
`
`3. Biologics
`
`4. NVM5 Intraoperative Monitoring System
`Addendum A: Healthcare Acronyms
`Addendum B: Glossary of Reimbursement Terms
`
`2
`3
`3
`12
`13
`14
`16
`16
`16
`17
`18
`18
`19
`19
`20
`21
`25
`26
`27
`27
`27
`28
`28
`29
`30
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`1
`
`

`

`2014 Reimbursement Guide
`I. INTRODUCTION
`This Reimbursement Guide has been prepared to assist physicians and facilities (“providers”) in accurately billing for NuVasive®
`implants and instrumentation systems. The NuVasive corporate headquarters houses a state-of-the-art education center and
`cadaver operating lab, designed to provide training and education to physicians on these technologies.
`
`This information details our general understanding of the application of certain codes to NuVasive products. It is the provider’s
`responsibility to determine and submit appropriate codes, charges, and modifiers for the products and services rendered.
`Payors may have additional or different coding and reimbursement requirements. Therefore, before filing any claim, providers
`should verify these requirements in writing with local payors. For more information, visit www.nuvasive.com.
`
`Spine Reimbursement Support
`800-211-0713 or reimbursement@nuvasive.com
`Working with professional medical societies and legislators, NuVasive has taken an active role regarding reimbursement for
`spine products and procedures. To assist providers with coding and denial issues, NuVasive established Spine Reimbursement
`Support assistance, available at 800-211-0713 or reimbursement@nuvasive.com. Please use this resource for
`reimbursement questions regarding any of the NuVasive products and associated procedures.
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`2
`
`

`

`II. PHYSICIAN CODING AND PAYMENT
`When physicians bill for services performed, payors require the physician to assign a Current Procedural Terminology (or
`CPT ®) code to classify or identify the procedure performed. These CPT codes are created and maintained by the American
`Medical Association (AMA) and are reviewed and revised on an annual basis. The most commonly used CPT codes are
`referred to as Category I codes and are five-digit codes accompanied by narrative descriptions.
`
`The AMA assigns a number of relative value units (or RVUs) to most CPT codes to represent the physician work, malpractice
`costs, and practice expenses associated with a given procedure or service. Medicare annually revises a dollar conversion factor
`that, when multiplied by the code’s RVUs, results in the national Medicare reimbursement for that procedure. Most private
`payors also consider a code’s RVUs when establishing physician fee schedules.
`
`Industrial or work-related injury cases are usually paid according to state-established fee schedules or percentage of billed
`charges. A state-appointed agency or private third party payors handle administration of workers’ compensation benefits
`and claims.
`
`1. FUSION FACILITATING TECHNOLOGIES
`The following CPT codes are generally used to report a decompression and/or arthrodesis procedures. The codes listed here
`are examples only, not an exhaustive listing. It is always the physician’s responsibility to determine and submit appropriate
`codes, charges, and modifiers for the services that were rendered.
`
`CPT CODING FOR ARTHRODESIS USING THE NUVASIVE® MAXCESS® SYSTEM
`NASS provided coding guidance for physicians when performing a fusion through an anterolateral approach. During an XLIF®
`lateral approach procedure, the patient is typically positioned laterally in order to spread the abdominal muscles to approach
`the lumber spine via a retroperitoneal exposure. The iliopsoas muscle is either split or mobilized to access the anterior spine
`from the lateral approach. The target of this approach is the vertebral body and anterior interspace. The physician is therefore
`performing an anterior fusion through an anterolateral approach. For this reason, NASS recommended the use of the anterior
`arthrodesis CPT code 22558, as well as the applicable instrumentation code(s) to describe the procedure.
`
`When obtaining preauthorization for this procedure, please keep the following key points in mind:
`• Include trade names of the devices to ensure appropriate review by payors. Payors may establish coverage criteria based
`on the specific devices/approach. In addition, utilize recognized correct coding nomenclature.
`• Medical necessity for the fusion must be established through relevant patient diagnosis codes.
`• Preauthorization should be requested for all relevant procedure codes for the case (e.g., anterior arthrodesis, posterior
`arthrodesis, instrumentation, graft material, nerve monitoring, etc.).
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`3
`
`

`

`2014 Reimbursement Guide
`Decompression Procedure Codes
`
`CPT® CODE1
`
`MODIFIER
`(IF WARRANTED)
`
`PROCEDURE DESCRIPTION
`
`63001
`
`63003
`
`63005
`
`63015
`
`63016
`
`63017
`
`63020
`
`63030
`
`63035
`
`63040
`
`63042
`
`63043
`
`63044
`
`63045
`
`Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without
`facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; cervical
`
`Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without
`facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; thoracic
`
`Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without
`facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; lumbar,
`except for spondylolisthesis
`
`Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy,
`foraminotomy or discectomy (e.g., spinal stenosis), more than 2 vertebral segments; cervical
`
`Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy,
`foraminotomy or discectomy (e.g., spinal stenosis), more than 2 vertebral segments; thoracic
`
`Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without
`facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), more than 2 vertebral segments; lumbar
`
`Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy,
`foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical
`
`Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy,
`foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar
`
`Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy,
`foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar
`(List separately in addition to code for primary procedure)
`
`Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy,
`foraminotomy and/or excision of herniated intervertebral disc, re-exploration, single interspace; cervical
`
`Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy,
`foraminotomy and/or excision of herniated intervertebral disc, re-exploration, single interspace; lumbar
`
`Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy,
`foraminotomy and/or excision of herniated intervertebral disc, re-exploration, single interspace; each
`additional cervical interspace (List separately in addition to code for primary procedure)
`
`Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy,
`foraminotomy and/or excision of herniated intervertebral disc, re-exploration, single interspace; each
`additional lumbar interspace (List separately in addition to code for primary procedure)
`
`Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord,
`cauda equina and/or nerve root[s] [e.g., spinal or lateral recess stenosis]), single vertebral segment; cervical
`
`-50
`
`-50
`
`-50
`
`-50
`
`-50
`
`-50
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`4
`
`

`

`Decompression Procedure Codes (cont.)
`
`CPT® CODE1
`
`MODIFIER
`(IF WARRANTED)
`
`PROCEDURE DESCRIPTION
`
`63046
`
`63047
`
`63048
`
`63055
`
`63056
`
`63057
`
`63064
`
`63075
`
`63076
`
`63077
`
`63078
`
`63081
`
`63082
`
`63085
`
`Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord,
`cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; thoracic
`
`Laminectomy, facetectomy and foraminotomy, (unilateral or bilateral with decompression of spinal cord,
`cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; lumbar
`
`Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord,
`cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; each
`additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure)
`
`Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated
`intervertebral disc), single segment; thoracic
`
`Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated
`intervertebral disc), single segment; lumbar (including transfacet or lateral extraforaminal approach) (e.g.,
`far lateral herniated intervertebral disc)
`
`Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated
`intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition
`to code for primary procedure)
`
`Costovertebral approach with decompression of spinal cord or nerve root(s) (e.g., herniated intervertebral
`disc), thoracic; single segment
`
`Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy;
`cervical, single interspace
`
`Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy;
`cervical, each additional interspace (List separately in addition to code for primary procedure)
`
`Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy;
`thoracic, single interspace
`
`Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy;
`thoracic, each additional interspace (List separately in addition to code for primary procedure)
`
`Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with
`decompression of spinal cord and/or nerve root(s); cervical, single segment
`
`Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with
`decompression of spinal cord and/or nerve root(s); cervical, each additional segment (List separately in
`addition to code for primary procedure)
`
`Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with
`decompression of spinal cord and/or nerve root(s); thoracic, single segment
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`5
`
`

`

`2014 Reimbursement Guide
`Decompression Procedure Codes (cont.)
`
`CPT® CODE1
`
`MODIFIER
`(IF WARRANTED)
`
`PROCEDURE DESCRIPTION
`
`63086
`
`63087
`
`63088
`
`63090
`
`63091
`
`Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with
`decompression of spinal cord and/or nerve root(s); thoracic, each additional segment (List separately in
`addition to code for primary procedure)
`
`Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach
`with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment
`
`Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach
`with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; each
`additional segment (List separately in addition to code for primary procedure)
`
`Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal
`approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or
`sacral; single segment
`
`Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal
`approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or
`sacral; each additional segment (List separately in addition to code for primary procedure)
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`6
`
`

`

`Spine Arthrodesis and Arthroplasty Procedure Codes
`
`PROCEDURE
`
`CPT® CODE1
`
`PROCEDURE DESCRIPTION
`
`POSTERIOR
`FUSION
`
`PLIF or TLIF
`
`ANTERIOR
`FUSION
`
`22595
`
`22600
`
`22610
`
`22612
`
`22614
`
`0334T
`
`22630
`
`22632
`
`22551
`
`22552
`
`22554
`
`22556
`
`22558
`
`22585
`
`22586
`
`0309T
`
`Arthrodesis, posterior technique, atlas-axis (C1-C2)
`
`Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment
`
`Arthrodesis, posterior or posterolateral technique, single level; thoracic, with lateral transverse
`technique, when performed
`
`Arthrodesis, posterior or posterolateral technique, single level; lumbar, with lateral transverse
`technique, when performed
`
`Each additional vertebral segment (List separately in addition to code for primary procedure).
`
`Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally disruptive (indirect
`visualization), includes obtaining and applying autograft or allograft (structured or morselized), when
`performed, includes image guidance when preformed (e.g., CT or fluoroscopic)
`
`Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare
`interspace (other than for decompression), single interspace; lumbar
`
`Each additional interspace (List separately in addition to code for primary procedure)
`
`Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy, and
`decompression of spinal cord and/or nerve root(s); cervical below C2
`
`Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and
`decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace
`(List separately in addition to code for separate procedure)
`
`Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace
`(other than for decompression); cervical below C2
`
`Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other
`than for decompression); thoracic
`
`Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other
`than for decompression); lumbar
`
`Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other
`than for decompression); each additional interspace
`
`Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with
`posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1.
`
`Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with
`posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar
`L4-L5 interspace
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`7
`
`

`

`2014 Reimbursement Guide
`Spine Arthrodesis and Arthroplasty Procedure Codes (cont.)
`
`PROCEDURE
`
`CPT® CODE1
`
`PROCEDURE DESCRIPTION
`
`COMBINED
`FUSION
`
`CERVICAL DISC
`ARTHROPLASTY
`
`22633
`
`22634
`
`22856
`
`22861
`
`22864
`
`Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique,
`including laminectomy and/or discectomy sufficient to prepare interspace (other than for
`decompression); single interspace and segment, lumbar
`(Do not report with 22612 or 22630 at the same level)
`
`Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique,
`including laminectomy and/or discectomy sufficient to prepare interspace (other than for
`decompression); each additional interspace and segment, lumbar
`(Do not report with 22612 or 22630 at the same level)
`(List separately in addition to code for primary procedure)
`(Use 22634 in conjunction with 22633)
`
`Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate
`preparation (includes osteophytectomy for nerve root or spinal cord decompression and
`microdissection), single interspace, cervical
`(Do not report 22856 in conjunction with 22554, 22845, 22851, 63075 when performed at the
`same level)
`(Do not report 22856 in conjunction with 69990)
`(For additional interspace cervical total disc arthroplasty, use 0092T)
`
`Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single
`interspace; cervical
`(Do not report 22861 in conjunction with 22845, 22851, 22864, 63075 when performed at the
`same level)
`(Do not report 22861 in conjunction with 69990)
`
`Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical
`22864 in conjunction with 22861, 69990)
`(For additional interspace removal of cervical total disc arthroplasty, use 0095T)
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`8
`
`

`

`Grafting and Lumbar Instrumentation Procedure Codes
`
`PROCEDURE
`
`CPT® CODE1
`
`PROCEDURE DESCRIPTION
`
`ALLOGRAFT &
`AUTOGRAFT
`
`POSTERIOR
`INSTRUMENTATION
`
`ANTERIOR
`INSTRUMENTATION
`
`INTERVERTEBRAL
`DEVICES
`
`20930
`
`20931
`
`20936
`
`20937
`
`20938
`
`0221T
`
`22840
`
`22841
`
`22842
`
`22843
`
`22844
`
`22845
`
`22846
`
`22847
`
`22851
`
`Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List
`separately in addition to code for primary procedure)
`
`Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)
`
`Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar
`fragments) obtained from same incision (List separately in addition to code for primary procedure)
`
`Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or
`fascial incision) (List separately in addition to code for primary procedure)
`
`Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical
`(through separate skin or fascial incision) (List separately in addition to code for primary procedure)
`
`Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and
`placement of bone graft(s) or synthetic device(s), single level; lumbar
`
`Posterior non-segmental instrumentation (e.g., Harrington rod technique, pedicle fixation across
`1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation)
`(List separately in addition to code for primary procedure)
`
`Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary
`procedure)
`
`Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar
`wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)
`
`Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar
`wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure)
`
`Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and
`sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary
`procedure)
`
`Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary
`procedure)
`
`Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary
`procedure)
`
`Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for
`primary procedure)
`
`Application of intervertebral biomechanical device(s) (e.g., synthetic cage(s), methylmethacrylate) to
`vertebral defect or interspace (List separately in addition to code for primary procedure)
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
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`2014 Reimbursement Guide
`Surgical Modifiers in Spine Surgery
`The following are surgical modifiers that may be used by spine surgeons to describe specific surgical circumstances.
`
`Surgical Session or Same Day Modifiers
`These modifiers are appended to indicate a specific circumstance that occurred during a surgical procedure or the same day
`as a surgical procedure.
`
`Modifier 22 Increased Procedural Services
`When the work required to provide a service is substantially greater than typically required, the service may be identified
`by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the
`reason for the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity of patient’s condition,
`physical and mental effort required). Note: This modifier should not be appended to an E/M service.
`
`Modifier 50 Bilateral Procedure
`Unless otherwise identified in the listings, bilateral procedures that are performed at the same session should be identified
`by adding modifier 50 to the appropriate 5-digit code.
`
`Modifier 51 Multiple Procedures
`When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (e.g.,
`vaccines), are performed at the same session by the same provider, the primary procedure or service may be reported as listed.
`The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure(s) or service
`code(s). Note: This modifier should not be appended to designated “add-on” codes.
`
`Modifier 52 Reduced Services
`Under certain circumstances, a service or procedure is partially reduced or eliminated at the physician’s discretion. Under these
`circumstances, the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying
`that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic
`service. Note: For hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or canceled
`as a result of extenuating circumstances, or those that threaten the well-being of the patient prior to or after administration of
`anesthesia, see modifiers 73 and 74.* (See modifiers approved for ambulatory surgery center (ASC)/outpatient hospital use.)
`
`Modifier 53 Discontinued Procedure
`Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating
`circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic
`procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported
`by the physician for the discontinued procedure. Note: This modifier is not used to report the elective cancellation of a
`procedure prior to the patient’s anesthesia induction and/or surgical preparation in the operating suite. For ASC/outpatient
`hospital reporting of a previously scheduled procedure/service that is partially reduced or canceled as a result of extenuating
`circumstances, or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers
`73 and 74.* (See modifiers approved for ASC/outpatient hospital use.)
`
`*For complete information on modifiers, see AMA CPT.
`
`QUESTIONS? CONTACT NUVASIVE® SPINE REIMBURSEMENT SUPPORT BY CALLING 800-211-0713 OR EMAILING reimbursement@nuvasive.com. THE INFORMATION PROVIDED IS GENERAL CODING INFORMATION ONLY; IT IS NOT
`ADVICE ABOUT HOW TO CODE, COMPLETE, OR SUBMIT ANY PARTICULAR CLAIM FOR PAYMENT. IT IS ALWAYS THE PROVIDER’S RESPONSIBILITY TO DETERMINE AND SUBMIT APPROPRIATE CODES, CHARGES, MODIFIERS, AND BILLS FOR THE SERVICES
`THAT WERE RENDERED. PAYORS OR THEIR LOCAL BRANCHES MAY HAVE THEIR OWN CODING AND REIMBURSEMENT REQUIREMENTS. BEFORE RENDERING IOM SERVICES, PROVIDERS SHOULD OBTAIN PREAUTHORIZATION FROM THE PAYOR.
`
`10
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`

`

`Modifier 59 Distinct Procedural Service
`Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from
`other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, (other than E/M
`services), that are not normally reported together, but are appropriate under the circumstances. Documentation must
`support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate
`lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day
`by the same individual. However, when another already established modifier is appropriate, it should be used rather than
`modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances,
`should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and
`distinct E/M service with a non-E/M service performed on the same date, see modifier 25.*
`*For complete information on modifiers, see AMA CPT.
`
`Modifier 76 Repeat Procedure or Service by Same Physician or Other Qualified Healthcare Professional
`It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified healthcare
`professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to
`the repeated procedure or service. Note: This modifier should not be appended to an E/M service.
`
`Modifier 77 Repeat Procedure by Another Physician or Other Qualified Healthcare Professional
`It may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified
`healthcare professional subsequent to the original procedure or service. This circumstance may be reported by adding
`modifier 77 to the repeated procedure or service. Note: This modifier should not be