1. Reporting all proper components of a procedure
Since spinal surgery is so complex, coding for these procedures involves many components. While only one or two codes may be assigned to many orthopedic procedures, it's not uncommon to list five or more CPT codes for a spinal procedure. Therefore, it is important for surgeons to document and report details of their procedures in the body of the operative report. Information should include identifying the spinal regions, specific segments fused and instrumented, noting whether the nerves were decompressed and how they were decompressed and specifying the type of cages, spacers and bone grafts used. Each of the components listed above have multiple codes to describe their placement and each has the potential to impact reimbursement. There are several guidelines in place instructing coders on the correct assignment of the codes. Medtronic has developed a laminated, pocket-sized Physician Guide to Spine Surgery Documentation to help remind physicians as they dictate operative reports to include specific information as applicable. It can be downloaded at www.sofamordanek.com/spineline/hospital/pocketguide.pdf.
2. Determining National Correct Coding Initiative edit pairs
Another coding challenge is determining which procedures can be listed separately and which have to be included as part of a larger, "bundled" procedure. To provide guidance, CMS has developed the NCCI edits specifically for the musculoskeletal system. The list, effective until the end of the year, is available for free by clicking here. The NCCI lists column 1/column 2 edits, previously known as comprehensive/component edits, and mutually exclusive edits. Comprehensive and component edits basically indicate that a procedure is a component of or is integral to a larger procedure. The NCCI also lists mutually exclusive edit pairs, which denote procedures that could not possibly be performed during the same operative session. There are several guidelines that describe when you can unbundle edits, but unbundling is rarely allowed under NCCI. Meanwhile, many private payors have established their own edit rules that are different from NCCI.
3. Getting reimbursed for category III codes
Category III codes are used for new technology, but getting reimbursed for them can be quite challenging. Claims processing systems at some payors cannot accommodate Category III codes, so these payors have assigned different codes to these procedures. Also, many payors refuse — at least initially — to reimburse for Category III procedures because they consider them investigational or experimental. Practices may need to make an extra effort to file these, but it is worth it because each claim, whether it is reimbursed or not, at least gets the payor's attention, raising the likelihood that it will reconsider its reimbursement policies. Each Category III claim is a "vote" for coverage. Medtronic's Therapy Access Solutions group can assist surgeons in appealing reimbursement denials involving Medtronic products. Call the TAS group toll-free at (866) 446-3873.
To reach SpineLine, call (877) 690-5353. Medtronic also offers free coding and reimbursement Webinars. To learn more information about these Webinars or to register, visit www.medtronicspinal.com/spineline.
Guide to Spinal Coding From Medtronic's Top Coding AnalystWritten by Leigh Page | October 23, 2009
SpineLine, Medtronic's coding and reimbursement support line, receives thousands of queries each year, and Leigh Evans, MBA, RHIA, CCS, CCS-P, CPC, the senior coding and reimbursement analyst at Medtronic, personally deals with many of them. Here Ms. Evans addresses three common challenges concerning proper spinal coding.