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Coding tip: Code biomechanical implants per intervertebral space

Ambulatory Surgery Reimbursement Update, July 17, 2007

When you code biomechanical implants, keep in mind that CPT code 22851, used for the application of intervertebral biomechanical device(s) (e.g., synthetic cage(s), threaded bone dowel(s), and methylmethacrylate) to vertebral defects or interspaces, is not intended to be reported per cage, but once per intervertebral space.

If a biomechanical implant (cage) was placed at two different levels of the spine (L3-4 and L4-5), then you can bill CPT code 22851 more than once to indicate the fact that the cages were placed at two different levels.

You should note that a single cage or methelymethacrylate can cover a defect of several vertebral segments, whereas you would only report CPT code 22851 once (e.g., a single cage may span three entire vertebrae).

Some payers may require you to append modifier -59 to the second CPT code (e.g., 22851 L3-4 and 22851-59 L4-5). If you have supporting documentation confirming that instrumentation was used, you can report those procedure codes (22840-22855) in addition to the definitive procedure.

If a physician performsperformed arthrodesis, you can also report the appropriate code from the 22548-22632 series.

CPT code 22851 is modifier -51 exempt for the physician's bill, and you should not use it on the ASC facility bill (since modifier -51 is used by physicians only and is not a facility modifier).

This tip is brought to you by Ellis Medical Consulting, Inc.

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