This one is a Spinal Fusion Practice Exam
Question. Q: The surgeon performed anterior fusion from
L1 to L3. What CPT code(s) are reported? A: A) 22630, 22632. And I have the codes down
here. The difference between the 558 and the 585 is the approach; it’s the anterior interbody
technique. The difference between 630 and 632 is that they’re the posterior interbody
technique. This one said the surgeon performed anterior
– so right off the bat, process of elimination, we’re going to throw out codes 22630 or
22632 because we’re dealing with an anterior fusion.
When I’m teaching questions from the nervous system or anything having to do with the spine,
I’ll tell you: stack your bones. Write them on the answer grid, on your documentation
that you’re coding from and put them on top of each other, just like they would show
on the real spine. So, it said L1 through L3 – so that would
mean you would write L1, L2 underneath that, L3 underneath that. So now you can quickly
visualize you’ve got 3 segments you’re dealing with and 2 interspaces. The space
between these is sometimes what the unit of measure is that we’re looking for, versus
the actual segments. This was an arthrodesis, which is a fusion
and therefore we’re talking about interspaces. It goes on to say in the CPT Index look up
Arthrodesis, Vertebra, Lumbar/ Anterior/ Anterolateral Approach which points to 22558. There are
interspaces between L1 – L2 and L2 – L3, so we need to code for one additional interspace
(not 2) using the add-on code 22585. That’s how you would break down that question.
This is what the codes look like in the manual versus taken from Super Coder. 22554 anterior
interbody technique, and then your 22630 is posterior. By looking at your manual, if you
have bubbled and highlighted that’s the technique that we teach in the Blitz, then
that is very visual cue to the difference. When you go back and you look at your [blip],
you now know what you’re abstracting for, because the way we teach is you look at the
answers first and then go read the [blip] to see what you’re looking for.
So, by looking at the answers first, you’d see, “OK, I have this batch here that’s
for anterior and I have this batch of codes that’s for posterior, what am I dealing
with?” And we decided it was anterior, so now we can get rid of all the codes on the
right-hand side of the page and just deal with these.
Then, we needed to figure out, we have a lumbar, 22558, so that’s your first lumbar then
it says “each additional interspace.” And because we stacked the bones, we could
clearly see we only had two interspaces, so that’s 22585; which makes the answer “D”