Transcription
DePuy Synthes2020 Spine Reimbursement GuidePhysician and Facility
ContentsThis guide has been developed to assist physicians and facilities in coding for the use of the DePuy Synthes Spineimplants and devices.These procedures may be a covered service if they meet all of the requirements established by Medicare and privatepayers. It is essential that each claim be coded properly and supported with appropriate documentation in themedical record.Physician Services3 CPT Codes Common Procedure Coding Scenarios Facility Services16Outpatient Services Ambulatory Payment Classifications (APCs) Ambulatory Surgery Center (ASC) Payment GroupsInpatient Services Medicare Severity Diagnosis Related Groups (MS-DRGs)Procedure Codes28 ICD-10-PCSDiagnosis Codes30 ICD-10-CMHCPCS Codes and Revenue Codes31Modifiers32Frequently Asked Questions for Stand Alone Devices34Frequently Asked Questions for for ViviGen Cellular Bone Matrix36DisclaimerTHE INFORMATION CONTAINED IN THIS DOCUMENT IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND REPRESENTS NO STATEMENT,PROMISE, OR GUARANTEE BY DEPUY SYNTHES CONCERNING LEVELS OF REIMBURSEMENT, PAYMENT, OR CHARGE. SIMILARLY, ALL CPT[COPYRIGHT AMA] AND HCPCS CODES ARE SUPPLIED FOR INFORMATIONAL PURPOSES ONLY AND REPRESENT NO STATEMENT, PROMISE, ORGUARANTEE BY DEPUY SYNTHES THAT THESE CODES WILL BE APPROPRIATE OR THAT REIMBURSEMENT WILL BE MADE. IT IS NOT INTENDED TOINCREASE OR MAXIMIZE REIMBURSEMENT BY ANY PAYOR. WE STRONGLY RECOMMEND THAT YOU CONSULT YOUR PAYOR ORGANIZATIONWITH REGARD TO ITS REIMBURSEMENT POLICIES.2020 Reimbursement GuideDePuy Synthes2
Physician ServicesCurrent Procedural Terminology (CPT ) codes and Medicare Physician Fee Schedule values for common spineprocedures are indicated below. CPT coding has been provided for the following procedural groups: Spinal Decompression Osteotomy and Corpectomy Thoracolumbar and SacroiliacJoint Arthrodesis Disc Arthroplasty Cervical Arthrodesis Laminoplasty Spinal Instrumentation Vertebroplasty and VertebralBody Augmentation Graft Placement Halo PlacementProcedure Codes for Spinal DecompressionCPT CodeDescription2020Total RVUs2020Medicare NationalAverage PaymentN/ACarrier Priced62380Endoscopic decompression of spinal cord, nerve root(s), includinglaminotomy, partial facetectomy, foraminotomy, discectomy and/orexcision of herniated intervertebral disc, 1 interspace, lumbar63001Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg,spinal stenosis), 1 or 2 vertebral segments; cervical35.72 1,28963003Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg,spinal stenosis), 1 or 2 vertebral segments; thoracic35.75 1,29063005Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg,spinal stenosis), 1 or 2 vertebral segments; lumbar, except forspondylolisthesis34.44 1,24363011Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg,spinal stenosis), 1 or 2 vertebral segments; sacral31.42 1,13463012Laminectomy with removal of abnormal facets and/or pars interarticularis with decompression of cauda equina and nerve roots forspondylolisthesis, lumbar (Gill type procedure)34.54 1,24763015Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg,spinal stenosis), more than 2 vertebral segments; cervical42.77 1,54463016Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg,spinal stenosis), more than 2 vertebral segments; thoracic44.01 1,58863017Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg,spinal stenosis), more than 2 vertebral segments; lumbar36.39 1,3132020 Reimbursement GuideDePuy Synthes3
CPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment63020Laminotomy (hemilaminectomy), with decompression of nerve root(s),including partial facetectomy, foraminotomy and/or excision ofherniated intervertebral disc; 1 interspace, cervical33.48 1,20863030Laminotomy (hemilaminectomy), with decompression of nerve root(s),including partial facetectomy, foraminotomy and/or excision ofherniated intervertebral disc; 1 interspace, lumbar28.11 1,01463035Laminotomy (hemilaminectomy), with decompression of nerve root(s),including partial facetectomy, foraminotomy and/or excision ofherniated intervertebral disc; each additional interspace, cervical orlumbar (List separately in addition to code for primary procedure)5.55 20063040Laminotomy (hemilaminectomy), with decompression of nerve root(s),including partial facetectomy, foraminotomy and/or excision ofherniated intervertebral disc, reexploration, single interspace; cervical40.29 1,45463042Laminotomy (hemilaminectomy), with decompression of nerve root(s),including partial facetectomy, foraminotomy and/or excision ofherniated intervertebral disc, reexploration, single interspace; lumbar37.54 1,35563043Laminotomy (hemilaminectomy), with decompression of nerve root(s),including partial facetectomy, foraminotomy and/or excision ofherniated intervertebral disc, reexploration, single interspace; eachadditional cervical interspace (List separately in addition to code forprimary procedure)N/ACarrier Priced63044Laminotomy (hemilaminectomy), with decompression of nerve root(s),including partial facetectomy, foraminotomy and/or excision ofherniated intervertebral disc, reexploration, single interspace; eachadditional lumbar interspace (List separately in addition to code forprimary procedure)N/ACarrier Priced63045Laminectomy, facetectomy and foraminotomy (unilateral or bilateralwith decompression of spinal cord, cauda equina and/or nerve root[s],[eg, spinal or lateral recess stenosis]), single vertebral segment; cervical37.19 1,34263046Laminectomy, facetectomy and foraminotomy (unilateral or bilateralwith decompression of spinal cord, cauda equina and/or nerve root[s],[eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic35.49 1,28163047Laminectomy, facetectomy and foraminotomy (unilateral or bilateralwith decompression of spinal cord, cauda equina and/or nerve root[s],[eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar31.90 1,15163048Laminectomy, facetectomy and foraminotomy (unilateral or bilateralwith decompression of spinal cord, cauda equina and/or nerve root[s],[eg, spinal or lateral recess stenosis]), single vertebral segment; eachadditional segment, cervical, thoracic, or lumbar (List separately inaddition to code for primary procedure)6.13 22163055Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment;thoracic47.03 1,69763056Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment;lumbar (including transfacet, or lateral extraforaminal approach) (eg, farlateral herniated intervertebral disc)43.08 1,55563057Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; eachadditional segment, thoracic or lumbar (List separately in addition tocode for primary procedure)9.28 3352020 Reimbursement GuideDePuy Synthes4
CPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment63064Costovertebral approach with decompression of spinal cord or nerveroot(s) (eg, herniated intervertebral disc), thoracic; single segment51.53 1,85963066Costovertebral approach with decompression of spinal cord or nerveroot(s) (eg, herniated intervertebral disc), thoracic; each additionalsegment (List separately in addition to code for primary procedure)5.97 21563075Discectomy, anterior, with decompression of spinal cord and/or nerveroot(s), including osteophytectomy; cervical, single interspace39.10 1,41163076Discectomy, anterior, with decompression of spinal cord and/or nerveroot(s), including osteophytectomy; cervical, each additional interspace(List separately in addition to code for primary procedure)7.14 25863077Discectomy, anterior, with decompression of spinal cord and/or nerveroot(s), including osteophytectomy; thoracic, single interspace43.62 1,57463078Discectomy, anterior, with decompression of spinal cord and/or nerveroot(s), including osteophytectomy; thoracic, each additional interspace(List separately in addition to code for primary procedure)6.01 2170274TPercutaneous laminotomy/laminectomy (interlaminar approach) fordecompression of neural elements, (with or without ligamentousresection, discectomy, facetectomy and/or foraminotomy), any method,under indirect image guidance (eg, fluoroscopic, CT), single or multiplelevels, unilateral or bilateral; cervical or thoracicN/ACarrier Priced0275TPercutaneous laminotomy/laminectomy (interlaminar approach) fordecompression of neural elements (with or without ligamentousresection, discectomy, facetectomy and/or foraminotomy), any methodunder indirect image guidance (eg, fluoroscopic, CT), with or withoutthe use of an endoscope, single or multiple levels, unilateral or bilateral;lumbarN/ARestricted Coverage2020Total RVUs2020Medicare NationalAverage PaymentProcedure Codes for Thoracolumbar and Sacroiliac Joint ArthrodesisProcedure codes for thoracolumbar arthrodesis through an anterior or lateral approachCPT CodeDescription22556Arthrodesis, anterior interbody technique, including minimal discectomyto prepare interspace (other than for decompression); thoracic48.18 1,73922558Arthrodesis, anterior interbody technique, including minimal discectomyto prepare interspace (other than for decompression); lumbar44.39 1,60222585Arthrodesis, anterior interbody technique, including minimal discectomyto prepare interspace (other than for decompression); each additionalinterspace (List separately in addition to code for primary procedure)9.51 34322586Arthrodesis, pre-sacral interbody technique, including disc spacepreparation, discectomy, with posterior instrumentation, with imageguidance, includes bone graft when performed, L5-S1 interspace58.49 2,1112020 Reimbursement GuideDePuy Synthes5
CPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment22808Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3vertebral segments53.15 1,91822810Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7vertebral segments59.50 2,14722812Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or morevertebral segments63.91 2,306Procedure codes for thoracolumbar arthrodesis through a posterior or posterolateral approachand Sacroiliac joint arthrodesisCPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment22610Arthrodesis, posterior or posterolateral technique, single level; thoracic(with lateral transverse technique, when performed)36.66 1,32322612Arthrodesis, posterior or posterolateral technique, single level; lumbar(with lateral transverse technique, when performed)46.00 1,66022614Arthrodesis, posterior or posterolateral technique, single level; eachadditional vertebral segment (List separately in addition to code forprimary procedure)11.38 41122800Arthrodesis, posterior, for spinal deformity, with or without cast; up to6 vertebral segments39.34 1,41822802Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to12 vertebral segments61.11 2,20222804Arthrodesis, posterior, for spinal deformity, with or without cast; 13 ormore vertebral segments70.64 2,54622630Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression),single interspace; lumbar45.59 1,64522632Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression),single interspace; each additional interspace (List separately in additionto code for primary procedure)9.36 33822633Arthrodesis, combined posterior or posterolateral technique withposterior interbody technique including laminectomy and/ordiscectomy sufficient to prepare interspace (other than fordecompression), single interspace and segment; lumbar53.67 1,93722634Arthrodesis, combined posterior or posterolateral technique withposterior interbody technique including laminectomy and/ordiscectomy sufficient to prepare interspace (other than fordecompression), single interspace and segment, each additionalinterspace and segment (List separately in addition to code for primaryprocedure)14.41 52027279Arthrodesis, sacroiliac joint, percutaneous or minimally invasive(indirect visualization), with image guidance, includes obtaining bonegraft when performed, and placement of transfixing device25.34 91527280Arthrodesis, open, sacroiliac joint, including obtaining bone graft,including instrumentation, when performed39.22 1,4152020 Reimbursement GuideDePuy Synthes6
Procedure Codes for Cervical ArthrodesisProcedure codes for cervical arthrodesis through an anterior or anterolateral approachCPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment22548Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2(atlas-axis), with or without excision of odontoid process56.49 2,03922551Arthrodesis, anterior interbody, including disc space preparation,discectomy, osteophytectomy and decompression of spinal cord and/ornerve roots; cervical below C249.38 1,78222552Arthrodesis, anterior interbody, including disc space preparation,discectomy, osteophytectomy and decompression of spinal cord and/ornerve roots; cervical below C2; each additional interspace (Listseparately in addition to code for primary procedure)11.55 41722554Arthrodesis, anterior interbody technique, including minimal discectomyto prepare interspace (other than for decompression); cervical below C236.33 1,31122585Arthrodesis, anterior interbody technique, including minimal discectomyto prepare interspace (other than for decompression); each additionalinterspace (List separately in addition to code for primary procedure)9.51 343Procedure codes for cervical arthrodesis through a posterior or posterolateral approachCPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment22590Arthrodesis, posterior technique, craniocervical (occiput-C2)45.63 1,64722595Arthrodesis, posterior technique, atlas-axis (C1-C2)43.50 1,57037.29 1,34611.38 4112020Total RVUs2020Medicare NationalAverage Payment22840Posterior non-segmental instrumentation (eg, Harrington rodtechnique, pedicle fixation across 1 interspace, atlantoaxialtransarticular screw fixation, sublaminar wiring at C1, facet screwfixation) (List separately in addition to code for primary procedure)22.08 79722841Internal spinal fixation by wiring of spinous processes (List separatelyin addition to code for primary procedure)0.00Bundled Code22842Posterior segmental instrumentation (eg, pedicle fixation, dual rodswith multiple hooks and sublaminar wires); 3 to 6 vertebral segments(List separately in addition to code for primary procedure)22.18 8002260022614Arthrodesis, posterior or posterolateral technique, single level; cervicalbelow C2 segmentArthrodesis, posterior or posterolateral technique, single level; eachadditional vertebral segment (List separately in addition to code forprimary procedure)Procedure Codes for Spinal InstrumentationCPT CodeDescription2020 Reimbursement GuideDePuy Synthes7
CPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment22843Posterior segmental instrumentation (eg, pedicle fixation, dual rodswith multiple hooks and sublaminar wires); 7 to 12 vertebralsegments (List separately in addition to code for primary procedure)23.70 85522844Posterior segmental instrumentation (eg, pedicle fixation, dual rodswith multiple hooks and sublaminar wires); 13 or more vertebralsegments (List separately in addition to code for primary procedure)28.64 1,03422845Anterior instrumentation; 2 to 3 vertebral segments (List separatelyin addition to code for primary procedure)21.17 76422846Anterior instrumentation; 4 to 7 vertebral segments (List separatelyin addition to code for primary procedure)22.01 79422847Anterior instrumentation; 8 or more vertebral segments (Listseparately in addition to code for primary procedure)23.43 84622849Reinsertion of spinal fixation device37.75 1,36222853Insertion of interbody biomechanical device(s) (eg, synthetic cage,mesh) with integral anterior instrumentation for device anchoring(eg, screws, flanges), when performed, to intervertebral disc space inconjunction with interbody arthrodesis, each interspace (Listseparately in addition to code for primary procedure)7.52 27122854Insertion of intervertebral biomechanical device(s) (eg, synthetic cage,mesh) with integral anterior instrumentation for device anchoring(eg, screws, flanges), when performed, to vertebral corpectomy(ies)(vertebral body resection, partial or complete) defect, in conjunctionwith interbody arthrodesis, each contiguous defect (List separately inaddition to code for primary procedure)9.74 35222859Insertion of intervertebral biomechanical device(s) (eg, synthetic cage,mesh, methylmethacrylate) to intervertebral disc space or vertebralbody defect without interbody arthrodesis, each contiguous defect(List separately in addition to code for primary procedure)9.74 3522020Total RVUs2020Medicare NationalAverage PaymentProcedure Codes for Graft PlacementCPT CodeDescription20930Allograft, morselized, or placement of osteopromotive material, forspine surgery only (List separately in addition to code for primaryprocedure)0.00Bundled Code20931Allograft, structural, for spine surgery only (List separately in additionto code for primary procedure)3.22 11620936Autograft for spine surgery only (includes harvesting the graft; local(eg, ribs, spinous process, or laminar fragments) obtained from thesame incision (List separately in addition to code for primaryprocedure)0.00Bundled Code20937Autograft for spine surgery only (includes harvesting the graft);morselized (through separate skin or fascial incision) (List separatelyin addition to code for primary procedure)4.85 17520938Autograft for spine surgery only (includes harvesting the graft);structural, bicortical or tricortical (through separate skin or fascialincision) (List separately in addition to code for primary procedure)5.34 1932020 Reimbursement GuideDePuy Synthes8
Procedure codes for Osteotomy and CorpectomyOsteotomyCPT CodeDescription2020Total RVUs2020Medicare NationalAverage Payment22206Osteotomy of spine, posterior or posterolateral approach, 3 columns,1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic71.00 2,56222207Osteotomy of spine, posterior or posterolateral approach, 3 columns,1 vertebral segment (eg, pedicle/vertebral body subtraction); lumbar69.46 2,50722208Osteotomy of spine, posterior or posterolateral approach, 3 columns,1 vertebral segment (eg, pedicle/vertebral body subtraction); eachadditional vertebral segment (List separately in addition to code forprimary procedure)17.13 61822210Osteotomy of spine, posterior or posterolateral approach, 1 vertebralsegment; cervical51.75 1,86822212Osteotomy of spine, posterior or posterolateral approach, 1 vertebralsegment; thoracic43.25 1,56122214Osteotomy of spine, posterior or posterolateral approach, 1 vertebralsegment; lumbar43.42 1,56722216Osteotomy of spine, posterior or posterolateral approach, 1 vertebralsegment; each additional vertebral segment (List separately inaddition to primary procedure)10.56 38122220Osteotomy of spine, including discectomy, anterior approach, singlevertebral s
ICD-10-CM HCPCS Codes and Revenue Codes Modifiers . Laminectomy with exploration and/or decompression of spinal cord and/ or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis
