CERVICAL PROCEDURES PHYSICIAN CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) Procedure Description CPT Code Modifier Comments Anterior interbody fusion, with discectomy and 22551 first interspace decompression; cervical below C2 22552 each additional interspace Anterior Instrumentation 22845 2 – 3 vertebral segments 22846 4 – 7 vertebral segment 22847 8 or more vertebral segments Use of bone graft: Allograft (morselized) 20930 Add-on code Allograft (structural) 20931 Add-on code Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code Autograft (morselized, separate incision) 20937 Add-on code Autograft (structural, separate incision) 20938 Add-on code Note: Do not report 22554 or 22585 with 63075 or 63076 even if performed by different physicians. To report anterior cervical discectomy and interbody fusion at the same level during the same session, use 22551. Cervical Arthroplasty Procedure Description CPT Code Modifier Comments Total Disc Arthroplasty, Anterior Approach, Cervical 22856 single interspace Laminoplasty Procedure Description CPT Code Modifier Comments Laminoplasty, Cervical 63050 two or more vertebral segments With Reconstruction 63051 Current Procedural Terminology (CPT ®) copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Zimmer Coding Reference Guide Disclaimer The information in this document was obtained from third party sources and is subject to change without notice, including as a result in changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature and does not cover all situations or all payers’ rules or policies. The service and the product must be reasonable and necessary for the care of the pa- tient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patients’ medical condition, procedures performed and the products used. This document represents no promise or guarantee by Zimmer regarding coverage or payment for products or procedures by Medicare or other payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the hospital’s Medicare Part A fiscal intermediary, the physician’s Medicare Part B carrier, or to appropriate payers. Zimmer specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at 866-946-0444. CERVICAL PROCEDURES FACILITY CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) with Anterior Plate Procedure Description ICD-9-CM Code Comments Anterior column fusion, anterior approach, cervical 81.02 (C2 level or below) Discectomy 80.51 Insertion of interbody spinal fusion device 84.51 Fusion or refusion of 2-3 vertebrae (or) 81.62 Fusion or refusion of 4-8 vertebrae 81.63 Excision of bone for graft, other 77.79 harvested from the iliac crest or locally Intra-operative monitoring 00.94 Note: Instrumentation is included in the fusion code and not reported separately. If structural allograft is used, do not report code 84.51. Allograft is included in the fusion code and not separately reported. Cervical Arthroplasty Procedure Description ICD-9-CM Code Comments Cervical arthroplasty 84.62 Laminoplasty Procedure Description ICD-9-CM Code Comments Other exploration and decompression of spinal 03.09 canal The information in this document was obtained from third party sources and is subject to change without notice, including as a result in changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature and does not cover all situations or all payers’ rules or policies. The service and the product must be reasonable and necessary for the care of the patient to sup- port reimbursement. Providers should report the procedure and related codes that most accurately describe the patients’ medical condition, procedures performed and the products used. This document represents no promise or guarantee by Zimmer regarding coverage or payment for products or procedures by Medicare or other payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the hospital’s Medicare Part A fiscal intermediary, the physician’s Medicare Part B carrier, or to appropriate payers. Zimmer specifically disclaims liability or responsibility for the results or con- sequences of any actions taken in reliance on information in this document. For further assistance with coding questions, contact the Zimmer Reimbursement Hotline at 866-946-0444. Page 2 of 15 ZS-SA0662_A LUMBAR PROCEDURES PHYSICIAN CODING Anterior Lumbar Interbody Fusion (ALIF) with Posterior Instrumentation Procedure Description CPT Code Modifier Comments Anterior Interbody Fusion, Lumbar 22558 first interspace 22585 each additional interspace Application of Biomechanical Device (cages, etc.) 22851 first interspace, if applicable 22851 59 each additional interspace Posterior Instrumentation 22840 non-segmental instrumentation 22842 segmental; 3 – 6 vertebral segments 22843 segmental; 7 – 12 vertebral segments 22844 segmental; 13+ vertebral segments Use of bone graft: Allograft (morselized) 20930 Add-on code Allograft (structural) 20931 Add-on code Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code Autograft (morselized, separate incision) 20937 Add-on code Autograft (structural, separate incision) 20938 Add-on code ALIF with Anterior Instrumentation Procedure Description CPT Code Modifier Comments Anterior Interbody Fusion, Lumbar 22558 first interspace 22585 each additional interspace Application of Biomechanical Device (cages, etc.) 22851 first interspace, if applicable 22851 59 each additional interspace Anterior Instrumentation 22845 2 – 3 vertebral segments 22846 4 – 7 vertebral segments 22847 8 or more vertebral segments Use of bone graft: Allograft (morselized) 20930 Add-on code Allograft (structural) 20931 Add-on code Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code Autograft (morselized, separate incision) 20937 Add-on code Autograft (structural, separate incision) 20938 Add-on code Page 3 of 15 ZS-SA0662_A ALIF and Posterolateral Fusion (Classic 360° Procedure) Procedure Description CPT Code Modifier Comments Posterolateral Fusion, Lumbar 22612 first level 22614 each additional segment Anterior Interbody Fusion, Lumbar 22558 51 first interspace 22585 each additional interspace Posterior Instrumentation 22840 non-segmental instrumentation 22842 segmental; 3 – 6 vertebral segments 22843 segmental; 7 – 12 vertebral segments 22844 segmental; 13+ vertebral segments Application of Biomechanical Device (cages, etc.) 22851 for first interspace, if applicable 22851 59 each additional interspace Use of bone graft: Allograft (morselized) 20930 Add-on code Allograft (structural) 20931 Add-on code Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code Autograft (morselized, separate incision) 20937 Add-on code Autograft (structural, separate incision) 20938 Add-on code Posterior Lumbar Interbody Fusion (PLIF) or Transforaminal Lumbar Interbody Fusion (TLIF) with Posterior Instrumentation Procedure Description CPT Code Modifier Comments Posterior Interbody Fusion, Lumbar 22630 first interspace 22632 each additional interspace Application of Biomechanical Device (cages, etc.) 22851 first interspace, if applicable 22851 59 each additional interspace Posterior Instrumentation 22840 non-segmental instrumentation 22842 segmental; 3 – 6 vertebral segments 22843 segmental; 7 – 12 vertebral segments 22844 segmental; 13+ vertebral segments Use of bone graft: Allograft (morselized) 20930 Add-on code Allograft (structural) 20931 Add-on code Autograft (rib/lamina/spinous process, same incision) 20936 Add-on code Autograft (morselized, separate incision) 20937 Add-on code Autograft (structural, separate incision) 20938 Add-on code Note: Codes 63030 and 63047 are bundled per the NCCI edits with code 22630. CPT® Assistant (January 2001, page 12) states that these codes can be reported in addition to the fusion code if performed for decompression (apply modifier-59 to the decompression code in this instance.) Page 4 of 15 ZS-SA0662_A Laminectomy, Lumbar Procedure Description CPT Code Modifier Comments Laminectomy without facetectomy, foraminotomy or 63005 one or two vertebral segments discectomy ,lumbar, except for spondylolisthesis 63017 more than 2 vertebral segments Laminectomy with removal of abnormal facets and/or 63012 Gill-type procedure pars interarticularis with decompression, for spondylolis- thesis, lumbar Laminotomy (hemilaminectomy), including partial 63030 one interspace facetectomy, foraminotomy and/or excision of herniated disc, lumbar 63035 each additional interspace Laminotomy (hemilaminectomy), including partial 63042 one interspace facetectomy, foraminotomy and/or excision of herniated disc, re-exploration, lumbar 63044 each additional interspace Laminectomy, facetectomy and foraminotomy, lumbar 63047 single vertebral segment 63048 each additional segment PLIF/TLIF and Posterolateral Fusion (Single Incision 360°) Procedure Description CPT Code Modifier