Forum - Questions & Answers

Sep 15th, 2015 - RNlady92707

Exploration of Cervical Fusion

Doctor performed a exploration of posterior fusion of cervical spine with removal and insertion of fusion cages of C3-C6 with new C3 being new added section of fusion. Codes 22830 was billed in addition to 13160 of secondary closure of surgical. 13160 was billed related to prior surgical site of scar tissue and muscles that had dehisced from prior surgeries. Insurance company willing to pay for 22830 but not the 13160 saying this is experimental and was not necessary. The muscles and scar tissue that to be stripped, cleaned and reattached to cervical spine unrelated to current surgery.

Sep 16th, 2015 - LBAROGIANIS 250 

re: Exploration of Cervical Fusion

Codemanager: Exploration (22830-22830)

To report instrumentation procedures, see 22840-22855. (Codes 22840-22848 and 22851 are reported in conjunction with code[s] for the definitive procedure[s]. When instrumentation reinsertion or removal is reported in conjunction with other definitive procedures including arthrodesis, decompression, and exploration of fusion, append modifier 51 to 22849, 22850, 22852 and 22855.) Code 22849 should not be reported with 22850, 22852, and 22855 at the same spinal levels. To report exploration of fusion, see 22830. (When exploration is reported in conjunction with other definitive procedures, including arthrodesis and decompression, append modifier 51 to 22830.)

It seems that you are missing the instrumentaion code and a second level procedure code. As for 13160 I am not familar with that code but it appears that is for secondary closure, to me it means that the surgeon had to reclose the original surgery wound so if you were going to use that code than the surgeon had to make two incision sites. One for the fusion and then one for the closing of the first surgery wound. If he had to go in and redo the fusion, then you can't charge for both codes because the incision is included in the fusion code of 22830.

I would need to see the whole op report but it appears that you should be thinking of other codes to use since he stripped, cleaned and reattached the muscles to c spine.

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