Strategies To Pep Up Your Plif Claims Success

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erior lumbar interbody fusion (PLIF), take special care to review the documentation for details on instrumentation placement and notes on other procedures carried out at the same time. If you miss these separate services, you risk lowering your payments.


However, whether you can report laminectomy separately, depends on the extent of the surgeon's effort.


Turn to 22632 for additional interspaces


For a standard PLIF procedure, you should go for 22630 (Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace [other than for decompression], single interspace; lumbar).


If the surgeon tends to additional interspaces beyond the first, you should use +22632 ( each additional interspace [list separately in addition to code for primary procedure]) for each additional interspace.
Keep bone grafts, interbody devices, and pedicle screws separate


If you are using arthrodesis (22630 and 22632), do not forget about bone grafts that the surgeon places to stabilize the spine.


Normally, ...
... surgeons will use either an allograft (20931, allograft for spine surgery only; structural), which describes bone that comes from a bone bank, or an autograft (20938, autograft for spine surgery only [includes harvesting the graft]; structural, bicortical or tricortical [through separate skin or fascial incision]), in which the bone comes from the patient's own body.


Apprehension about the separate site incision with risks of postoperative infection and pain have led many surgeons to go for structural allograft over autograft options.


Some surgeons also use an interbody prosthetic device (22851, Application of intervertebral biomechanical device(s) (for instance, synthetic cage(s), methylmethacrylate) to vertebral defect or interspace [List separately in addition to code for primary procedure]). This code doesn't apply to machined bone, which should be reported as 20931. Code 22851 should be reported once per interspace, irrespective of the number of prosthetic devices placed within one interface. If more than one interspace receives a prosthetic device, code 22851 may be reported again for each interspace appended with the -59 modifier. With revision to code 22851, threaded bone allograft is now reported with 20931 rather than 22851.


However, depending on circumstances, surgeons can select any procedure from the 20930-20938 series for bone grafts.


Bundle 'standard' Laminectomy


As laminectomy is a standard component of arthrodesis required to access and prepare the interspace for surgery, you should not regularly report 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s) (example, spinal or lateral recess stenosis)], single vertebral segment; lumbar) in addition to 22630/22632, according to CPT Assistant, December 1999 and January 2001.


But again you may report arthrodesis and laminectomy separately in some circumstances, states CPT Assistant. Particularly, the January 2001 CPT Assistant states that you should report 63045-63048 as proper, when in addition to removing the disk and preparing the vertebral endplate, the surgeon removes posterior osteophytes and decompresses the spinal cord or nerve root(s), which requires work in excess of that is normally performed when doing a posterior lumbar interbody fusion (PLIF)."


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