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Topic Title: Cervical Disc Arthroplasty Code Help Needed
Topic Summary: Need specific coding guidance/feedback
Created On: 12/17/2010 09:04 PM

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 12/17/2010 09:04 PM
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88yates@comcast.net

Posts: 1
Joined: 12/17/2010

I am a patient (not a coder) who will be having multi-level cervical artificial disc replacement (arthroplasty) surgery in Europe. I am helping the European surgeon create the request for medical review documentation to submit to the insurance company. The European surgeon and his staff are not familiar with CPT Codes. The surgical procedure will consist of the following:

1. General anesthesia

2. Diagnostic discography with contrast at C4/5 to determine if that disc is bad; radiologist present with the surgeon

3. If bad, perform artificial disc replacement at C4/5 (arthroplasty); If not bad, proceed to next step.

4. Arthroplasty at C5/6 (known bad disc)

5. Arthroplasty at C6/7 (known bad disc)

********

I understand the following about the related CPT codes:

1. Codes for Cervical or Thoracic Discography

May be reported with 62291 and 72285. Both the surgical and RS&I codes should be reported once for each level injected and studied. 62291 is not supposed to be included separately with 22856, since it is now bundled with 22856.

72285: Discography, cervical or thoracic, radiological supervision and interpretation

2. Code for the Initial Cervical Arthroplasty Level

22856: 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

22856 also includes components 22505 (manipulation of spine), 62291 (spinal diskography), 22220 (spinal osteotomy) and 22600 (cervical arthrodesis, single level).

3. Code for the Additional Cervical Arthroplasty Levels

0092T: Revision including replacement of total disc arthroplasty, (artificial disc), anterior approach; each additional interspace, cervical (list separately in addition to code for primary procedure)

4. Modifier - 57 is used to indicate a procedure used to make a decision for surgery.

********

So, having said all that, I am trying to determine how the procedure would be properly coded.

1. General anesthesia - I have seen multiple codes and do not know which is most commonly used and accepted. Does this even need to be included in a request for medical review/pre-approval, since it is an obvious requirement of this surgery?

2. Diagnostic discography with contrast at C4/5 - 72285. I was told that it is not appropriate to use the -57 modifier with this code. Is it correct to use this code by itself? I do not know if/how to report RS&I codes. Are RS&I codes necessary for a request for medical review/pre-approval?

3. Arthroplasty at C4/5 if bad - 22856. If disc not bad, skip to next step.

4. Arthroplasty at C5/6 - If 22856 was done in #3, then 092T, if not, then 22856.

5. Arthroplasty at C6/7 - 092T

I'm just a patient looking for some desperately needed help. I will be especially grateful for any that can be offered. Thanks! :)
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