Never Say ‘Never:’ How I Learned to Love CPT Coding of Spinal Procedures

There is always something new to learn in coding, and we must not limit ourselves because we may be intimidated.

You may feel you are in this position right now, due to changes in the Inpatient Only list. Spinal fusion procedures previously only performed in the inpatient setting are now performed outpatient. Therefore, outpatient coders have an opportunity to learn how to accurately code these complex procedures with CPT codes.

But we can do this! We are good at learning new concepts and applying them.

Getting Over My Fear: Spinal Procedures Comes Down to Four Basic Types 

I used to say that I would never code Neurosurgery. It was so intimidating to look at a detailed operative report for a spinal procedure and know that I was supposed to come up with not just one, but several CPT codes.

Then one year at the AMA CPT Symposium, one of the presenters gave a little primer on coding for spinal fusions, while introducing new codes. He broke it down to four basic types of spinal procedures:

1. Decompression – something is impinging on the spinal cord or the exiting nerves, and that something – usually bone – must be removed.
2. Arthrodesis – if bone has been removed, stability may need to be restored. This is sometimes accomplished by means of arthrodesis, or fusing one vertebrae to the next one. This is actually accomplished by coaxing, or setting up the vertebrae to grow together, or fuse themselves. (See step #4.)
3. Instrumentation – sometimes stability is restored to the spine by means of rods or cages inserted.
4. Bone Grafting – In order to coax the vertebrae to fuse, bone may be inserted. This could be the patient’s own bone obtained from step #1 or by using allograft, bone from the tissue bank, or by using a synthetic bone.

The key in coding for spine procedures is recognizing which of these has been performed and then choosing the appropriate codes. I understood the process a little better, but I still shied away from neurosurgery.

Neurosurgery – Taking the Plunge!

Then, several years ago, a client for whom I code every month, brought on three neurosurgeons. I decided I was tired of limiting myself, so I accepted the challenge to learn this new area. I dove in and learned the coding guidelines and studied payer policies.

Now, I love coding for these procedures! If you see me sitting at my desk counting on my fingers, it is likely I am coding spine procedures.

And yes, I reminded myself of that again recently when my client brought in a new neurosurgeon who performs neurointerventional procedures. I took on the challenge to learn something new!

Never Say ‘Never!’

Don’t go it alone!

Something new is always a little intimidating. But in almost every case, there is guidance available. LIbman Education’s spinal coding courses and Practical Coding Experience offerings are designed with real-world cases. We break down the coding guidelines and payer policies and then apply them to the operative reports a coder would see every day.

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