Category: CC-Neurosurgery


22633 with 22610

I’m trying to figure out how to code a procedure for precertification. My neurosurgeon said she’s going to do a T10-S1 fusion. She’s doing a combined interbody and posterolateral fusion (22633) at L4-L5 and posterolateral fusions at all the other levels. Do I code 22610 for the thoracic fusion with modifier 59 along with 22633 (L4-L5, combined fusions) and 22614 x 6 units for the other levels?



I have an operative report where the neurosurgeon performed L5-S1 minimal invasive transforaminal lumbar interbody fusion (TLIF) with L5/S1 and an instrumented fusion (pedicle screws/rods). He did a far lateral transforaminal approach to disc space with left L5/S1 facetectomy and discectomy. He also placed a PEEK cage for the interbody arthrodesis packed with morselized allograft and autograft.



I saw your Q&As on billing for weekend rounds – they were very helpful. What if my PA makes rounds on a patient, during the global period, that I operated on? The PA was not involved in the surgery and did not bill as an assistant for the procedure. So can my PA bill for weekend rounds? What if it is my neurosurgeon partner’s PA?


Denials of 69990

I get denials on 69990, the microscope code, when I billed it with 22551 (ACDF). I have a few payors that do reimburse but Medicare does not. Should I be using modifier 59 on 69990 to get paid? Please help me appeal these denials.


Co-Surgery Modifier (62) on Spinal Instrumentation

Hi, I have a case where I have two surgeons who did a fusion together. The codes were all billed with modifier 62. The commercial insurance denied for modifier 62 with code 22842. As I research, I realize CPT states modifier 62 is inappropriate with 22842, although I see that CMS payment policy still allows modifier 62 to be paid. As I read the report, I see that each surgeon did distinct parts - one surgeon did the right side while the other did the left pedicle screws/rod placement. Should I appeal the denial?


Billing for Placement of Head Frame

I just realized I may have been missing out on some revenue. My partner told me that he bills for placement of the patient in a head stabilization system on every case. I think he’s using CPT 20660. We are in an RVU compensation system, so capturing all CPT codes is important to me. Can I really bill for this?

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