the AANS Coding Reimbursement Team. And the intent of this short video is to introduce the principles of coding. Now, this is part of a three-part series that will give you an hour of CMA and hopefully begin to introduce the principles of coding that we need as we code our cases. Whether we are a resident beginning to learn coding, whether we are a finished a residency and beginning to collect our cases and assembling our case log, we actually have to submit codes that have to be vetted through the AANS. Or whether we are more seasoned and in practice and just wanna make sure that the procedures that we are submitting codes are correct and accurate and see if there's anything else that we can enhance, for example, in the pre-authorization process going through ICD-10 codes and a greater understanding of these things. Again, the hope is that across these three episodes, that we can achieve a very sophisticated understanding of coding and at the same time, get an hour of CMA. So let's get started. I'm gonna share my screen. And we are gonna get started with an introduction to spine coding. This is basic cervical coding. Again, we are starting from a standing start here, truly an introduction, the building blocks and the background and whatnot. So my disclosures, which have nothing to do with this talk. The first stop on our brief introduction is an overview of ICD-10. One of the things that I try and emphasize anytime I teach a coding course is to demystify ICD-10. It's not written in another language. It's familiarity with ICD-10 codes that actually can make life a lot easier. And I can tell you that I know ICD-10 codes much, much better than I ever knew ICD-9. And so all of that preparation really did help us out quite a bit. So the first question that I ask myself is what are the common cervical diagnosis codes? Well, you have cervicalgia, just about everyone shows up. It's gonna have some element of neck pain or they're not in our clinic. They're coming to see us about their neck. They're gonna have spondylosis, something we see obviously in the fourth and fifth decade of life because of the downstream consequences of time and gravity. Cervical radiculopathy can strike at just about any age group. Disc herniations, spondylosis causing radiculopathy. Stenosis we're seeing in our more older age groups. Obviously myelopathy is going to wrap that up in a spondylolisthesis malalignment of one particular body on another. So it'd be good to be able to have at the tips of our fingers ICD-10 codes that represent these things. Kyphosis is yet another diagnosis that we'll be seeing with the deformities that we see in our clinic. So this is a book that it is valuable to have by the computer where you're doing all your charting. Every once in a while, you wanna look something up when something off the beaten path has happened like a surfboard injury or a go-kart injury that you wouldn't be able to code with high degree of precision. But for the most part, there's gonna be a handful of cervical codes that I will go over in this talk that will give you great facility that you can apply in about 80 to 85% of all cervical patients in your clinic. So the first thing that we do is we open up chapter six and we get familiar with the diseases of the central nervous system. Those are the G0 through 99 codes. There are gonna be some valuable ones there Chapter 13 is where the meat of what we do resides. And that is gonna be where we see our stenosis, cervical radiculopathy, cervical spondylosis codes. And then trauma. Those of us who do trauma chapters 19 and 20, the S, T and V start codes. Those are the starting letter that organizes this. But again, there is method to the madness grabbing ahold of this book and flipping through it specifically chapter six, chapter 13, chapters 19 and 20. Those are gonna be where we get the majority of our codes. So the first one that we're gonna go with is we are going to look at the ICD-10 code for spondylolisthesis M43 TAC1. And then X is gonna be because we are going to give it a specific location, whether the occipital cervical, cervical or cervical thoracic. And in this case, this is a cervical thoracic listhesis as you can see down here. This is, there may be stenosis up here, cervical stenosis, but the listhesis is down below. Myelopathy. If you have myelopathy M47 TAC1-2 is gonna be the cervical version of this. And obviously you can see in this case advanced the MRI, you'd anticipate signal change abnormality or severe stenosis in the patients. Obviously it's not just a radiographic diagnosis. Cervical stenosis is a radiographic diagnosis. Myelopathy is the clinical symptoms of individuals who have a myelopathic exam, Romberg positive, muscle wasting, hand intrinsics that are up. More commonly spondylosis with radiculopathy M47 TAC in the cervical spine, TAC2-2. Then this is someone who has a cervical stenosis M48 TAC0-2 in this case, if it's down the cervical thoracic, it could be 0-3. Occipital lantoaxial in the case of rheumatoid arthritis in that vicinity, a PAN is causing stenosis there would be used with that code. The cervical disc disorder codes are the M50 codes. These are codes that are gonna have a very accurate, drill down to the level of the code, the level of the segment, even drilling it down, for example, M50 TAC1-2-2 is gonna give you a cervical disc with radiculopathy at C5-6. It can drill it down to that specificity. Kyphosis will have three flavors. It'll be secondary to trauma, can be unspecified or postural. And those are gonna be the codes that we give. For example, here, you have an individual with cervical kyphosis looks like it is post-traumatic, in which case we are gonna be using the M50 TAC1-2 code. This is an individual who had a cervical thoracic because of upward positive SVA. And it looks like studying that X-ray that there is no spinous process between C7 and T1. And that has resulted in splain. It's a secondary heterogenic kyphosis that has happened at the cervical thoracic junction. So these are commonly used codes. Cervicalgia, M50-4 TAC2, cervical spondylosis with radiculopathy, M47-TAC2-2, cervical spondylosis with myelopathy, M47-TAC1-2. If you have someone who just has spondylosis, but they have neck pain, but no radicular symptoms or myelopathy, M48-TAC812, and then cervical kyphosis. So what about, so now we have a basis with our ICD-10 codes. Now we can, and those are very important to put down and diagnose accurately so that we can put those on pre-authorization forms. But what about the CPT? How do we do the coding, which is the central focus of what it is that we're doing here? So let's ask ourselves what our common cervical surgeries are. Obviously the most common thing that we're gonna be doing is anterior cervical fusions, whether single level, multi-level. We do posterior cervical forensic surgery, we do posterior cervical foraminotomies, we do cervical laminectomies, we do laminectomies with fusion. And the general principles that we need to abide by as we begin coding our cervical cases is distilling it into its core principles. Are we decompressing? Yes or no. Are we using instrumentation? Yes or no. Are we using bone graft? Yes or no. And what type of bone graft? So the zip codes, as I call them, are decompression codes, which are in the 63,000 zip codes. 63020, for instance, would be a cervical foraminotomy for microdiscectomy. And then obviously it depends on where we are and that will impact the CPT code. Arthrodesis codes at 22,000 series and then instrumentation codes, 22,840. So 22840 is gonna be non-segmental instrumentation, 22842. And that's gonna be the same regardless of where we are than in our bone graft codes. So add-on codes, this is gonna have a plus sign in front of it. And those are gonna be our microscope codes. A lot of the microscope codes are bundled, computer-assisted navigation. If we are placing in, if we're using one of the various navigation systems, we would use that add-on code 61783. And then our instrumentation codes, this is going to include multiple levels, but the most common is 22840, 22842. 22841 is gonna be wiring the spinous processes together, something that we don't do as much. Instead of we're using the instrumentation codes, placing the screws into, whether it's the lateral mass of the cervical spine at C1 or the PARs at C2 or the lateral mass at the sub-axial spine. Once we are up past seven levels and including multiple, then we'd be in the 22843. And of course, my hope is never to have to do the 22844. Anti-instrumentation codes, less commonly used in the upper numbers, but 22845 is gonna be for our single-level, two-level ACDFs and beyond that, 22846. And then our inner body codes, we'll talk a little bit about that. The 22853, 5459 is a worthwhile decision of historical vignette to review about how codes can go on screens and then be divided up and the value, unfortunately, does diminish. So this is purely a historical vignette in 2017 because the 22851 was picked up on a screen because of its frequency of use. It was revalued in 2016. And then the RUC, which is the representative body of the AMA, the Relative Value Update Committee, went by or went and did a reevaluation with surveys. It is so important when we receive these surveys via email, I typically, when I get these surveys, it's tag on it. I stop what I'm doing and I do the survey. It's so important to have a good response rate, it's so important to have an accurate evaluation of how it is that we are doing these procedures for the valuation process that the representative body of the AMA called the RUC has to go through. Anyway, that is that process. And it happens, happened recently with the 63030 or microdiscectomy code because of a site of service. And so it's good to know what happens to a code, how codes, new codes, which don't happen with significant frequency, but it does happen. And this is how the 22853, 5459 came into play and because the 22851 came on a screen and then three new codes were developed and it was for the inner body spacer. 22854 is for the corpectomy, 22859 is the original spirit of the 22851 where it is to occupy a space not intended for arthrodesis. For example, when you're taking out a tumor and you put stymine pins and cement, that's not intended to ever fuse. It is intended just to hold up. It's a mechanical spacer that is not going to result in any arthrodesis. And that has to do, that's the origin of the code and how it was valued. So this is just a, again, more of a historical vignette. Bone grafts, these are important that we document, but these don't have a significant reimbursement, but it still allows us to capture what it is that we do. So when we go through the principles of coding, we ask ourselves, what was the ICD-10 diagnosis? And the reason that's important is because a lot of the CPT codes are diagnosis driven. Obviously it makes sense that if you have M47 TAC22, which is cervical spondylosis with radiculopathy, that it would be matched by a CPT that addresses that ICD-10. And so it's always very, it's ideal, it's a clean billing procedure to make sure that the ICD-10s make rational sense with the CPTs you're matching it. You have to ask yourself, what was the approach? Was the approach anterior or posterior? How many levels? What levels were included? Was there a decompression? Was there an arthrodesis? And was there instrumentation? And of course, bone graft. So you choose a standalone procedure for the decompression, discectomy activity. And again, these in the cervical spine, C1-2 has its own codes. The odontoids have their own codes. So you use a standalone code and then you start picking up your add-on codes for instrumentation, bone grafts, microdissection, whether or not you're using computer-assisted navigation. And then you come up with a code. So what are these common cervical codes? We're gonna go over a handful of common cervical codes and then part two of this webinar, this on-demand video is going to go through various coding scenarios. So obviously one of the most common is gonna be just an anterior cervical discectomy with fusion. And so it's a 22551, nothing exotic about that. You can see a plus sign in front of the 22552 because that's an add-on code that has to be added on to the 22551. You cannot have that as a standalone code. Then we have our corpectomy, single level, two level corpectomy. And then the arthrodesis that we do above and below at the interface of the corpectomy. There'll be examples of this in the second phase, the second segment of this series. Laminectomy codes, we're doing laminectomy 63001. That's laminectomy with exploration, decompression of the spinal cord without fast second foraminotomy, one or two levels. So that's basically, I'm just doing a trough laminectomy at one level where there was some stenosis. That's the code I would use there. I'm not doing a foraminotomy. So I wouldn't use the sixth, I wouldn't be using the laminectomy code that has foraminotomy included in it, which is 63045. That includes a foraminotomy over top of the nerve root. If I do my trough laminectomies, there'll be an example of this from C3 to C6 for central canal stenosis after a central cord, I would use 63015. Again, I'm not describing a foraminotomy or fastectomy. I'm just doing trough laminectomies. I wanna get the central canal bigger. 63045 is gonna be that laminectomy, fastectomy, foraminotomy code, single level. And then additional segments would be 63048. If we're doing a microdiscectomy, making a laminotomy and decompressing the nerve root, 63020. And then for each additional segment, 63035. Arthrodesis, if we're doing an occiput to C2, 22590, 22595 is gonna be just a C12. And after that, the below those levels is 22600 is for the cervical arthrodesis. And then each additional segment, 22614. Again, we're gonna have examples of this. So that wraps up this first installment of a introduction to cervical coding. Again, we went over the common cervical ICD-10 codes. We looked at the building blocks of coding, whether or not we're doing things anterior, posterior, decompression, arthrodesis, instrumentation and bone grafts. Then we went over several common CPT codes. The goal here is just to begin to lay the foundation for what we are going to cover in the subsequent two installments of this cervical series. I am going to go over those next and hopefully this was a valuable start. And then we will explore at a much greater level of complexity, the subsequent ones. So we will see you in the next one. Thanks for your attention.

coding

spine surgery

ICD-10 codes

CPT codes

cervical diagnosis codes