RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions

A57654

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
First Coast Service Options, Inc.	A and B MAC	09101 - MAC A	J - N	Florida
First Coast Service Options, Inc.	A and B MAC	09102 - MAC B	J - N	Florida
First Coast Service Options, Inc.	A and B MAC	09201 - MAC A	J - N	Puerto Rico Virgin Islands
First Coast Service Options, Inc.	A and B MAC	09202 - MAC B	J - N	Puerto Rico
First Coast Service Options, Inc.	A and B MAC	09302 - MAC B	J - N	Virgin Islands

Article Information

General Information

Article ID
A57654

Article Title
Billing and Coding: Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions

Article Type
Billing and Coding

Original Effective Date
10/03/2018

Revision Effective Date
01/01/2023

Revision Ending Date
03/28/2024

Retirement Date
03/28/2024

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33382, Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidelines

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
Medical record documentation maintained by the physician must include the following:

Complete operative report outlining operative approach used and all the components of the spine surgery.
Documentation of the history and duration of unsuccessful conservative therapy (non-surgical medical management) (for example, duration and outcomes of physiotherapy, injection therapy, anatomic factors influencing the decision for surgery, etc.) when applicable. Failure of non-surgical medical management can be historical and does not have to be under the direction of the operating surgeon.
Interpretation and reports for X-rays, MRI’s, CT’s, etc.
Medical clearance reports (as applicable).

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
999x	Not Applicable

Revenue Codes

Code	Description
99999	Not Applicable

CPT/HCPCS Codes

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Group 1

(21 Codes)

Group 1 Paragraph

The following CPT Group 1 codes associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time.

Note: The CPT codes 63052 and 63053 may only be reported for decompression at the same anatomic site(s) when posterior interbody fusion requires decompression beyond preparation of the interspace(s) for fusion.

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes

Code	Description
22533	Arthrd lat xtrcvtry tq lmbr
22534	Arthrd lat xtrcvtry tq ea ad
22558	Arthrd ant ntrbd min dsc lum
22585	Arthrd ant ntrbd min dsc ea
22612	Arthrd pst tq 1ntrspc lumbar
22614	Arthrd pst tq 1ntrspc ea add
22630	Arthrd pst tq 1ntrspc lum
22632	Arthrd pst tq 1ntrspc lm ea
22633	Arthrd cmbn 1ntrspc lumbar
22634	Arthrd cmbn 1ntrspc ea addl
22800	Arthrd pst dfrm<6 vrt sgm
22802	Arthrd pst dfrm 7-12 vrt sgm
22804	Arthrd pst dfrm 13+ vrt sgm
22808	Arthrd ant dfrm 2-3 vrt sgm
22810	Arthrd ant dfrm 4-7 vrt sgm
22812	Arthrd ant dfrm 8+ vrt sgm
22853	Insj biomechanical device
22854	Insj biomechanical device
22859	Insj biomechanical device
63052	Lam facetc/frmt arthrd lum 1
63053	Lam factc/frmt arthrd lum ea

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(1 Code)

Group 1 Paragraph

The following ICD-10-PCS codes associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time.

Part A ICD-10 PCS codes

0RGA0A0 Fusion of thoracolumbar vertebral joint with interbody fusion device, anterior approach, anterior column, open approach

0RGA0AJ Fusion of thoracolumbar vertebral joint with interbody fusion device, posterior approach, anterior column, open approach

0SG0070 Fusion of lumbar vertebral joint with autologous tissue substitute, anterior approach, anterior column, open approach

0SG0071 Fusion of lumbar vertebral joint with autologous tissue substitute, posterior approach, posterior column, open approach

0SG007J Fusion of lumbar vertebral joint with autologous tissue substitute, posterior approach, anterior column, open approach

0SG00AJ Fusion of lumbar vertebral joint with interbody fusion device, posterior approach, anterior column, open approach

0SG00A0 Fusion of lumbar vertebral joint with interbody fusion device, anterior approach, anterior column, open approach

0SG00J0 Fusion of lumbar vertebral joint with synthetic substitute, anterior approach, anterior column, open approach

0SG00J1 Fusion of lumbar vertebral joint with synthetic substitute, posterior approach, posterior column, open approach

0SG00JJ Fusion of lumbar vertebral joint with synthetic substitute, posterior approach, anterior column, open approach

0SG00K0 Fusion of lumbar vertebral joint with nonautologous tissue substitute, anterior approach, anterior column, open approach

0SG00K1 Fusion of lumbar vertebral joint with nonautologous tissue substitute, posterior approach, posterior column, open approach

0SG00KJ Fusion of lumbar vertebral joint with nonautologous tissue substitute, posterior approach, anterior column, open approach

0SG1070 Fusion of 2 or more lumbar vertebral joints with autologous tissue substitute, anterior approach, anterior column, open approach

0SG1071 Fusion of 2 or more lumbar vertebral joints with autologous tissue substitute, posterior approach, posterior column, open approach

0SG107J Fusion of 2 or more lumbar vertebral joints with autologous tissue substitute, posterior approach, anterior column, open approach

0SG10A0 Fusion of 2 or more lumbar vertebral joints with interbody fusion device, anterior approach, anterior column, open approach

0SG10AJ Fusion of 2 or more lumbar vertebral joints with interbody fusion device, posterior approach, anterior column, open approach

0SG10J0 Fusion of 2 or more lumbar vertebral joints with synthetic substitute, anterior approach, anterior column, open approach

0SG10J1 Fusion of 2 or more lumbar vertebral joints with synthetic substitute, posterior approach, posterior column, open approach

0SG10JJ Fusion of 2 or more lumbar vertebral joints with synthetic substitute, posterior approach, anterior column, open approach

0SG10K0 Fusion of 2 or more lumbar vertebral joints with nonautologous tissue substitute, anterior approach, anterior column, open approach

0SG10K1 Fusion of 2 or more lumbar vertebral joints with nonautologous tissue substitute, posterior approach, posterior column, open approach

0SG10KJ Fusion of 2 or more lumbar vertebral joints with nonautologous tissue substitute, posterior approach, anterior column, open approach

0SG3070 Fusion of lumbosacral joint with autologous tissue substitute, anterior approach, anterior column, open approach

0SG3071 Fusion of lumbosacral joint with autologous tissue substitute, posterior approach, posterior column, open approach

0SG307J Fusion of lumbosacral joint with autologous tissue substitute, posterior approach, anterior column, open approach

0SG30A0 Fusion of lumbosacral joint with interbody fusion device, anterior approach, anterior column, open approach

0SG30AJ Fusion of lumbosacral joint with interbody fusion device, posterior approach, anterior column, open approach

0SG30J0 Fusion of lumbosacral joint with synthetic substitute, anterior approach, anterior column, open approach

0SG30J1 Fusion of lumbosacral joint with synthetic substitute, posterior approach, posterior column, open approach

0SG30JJ Fusion of lumbosacral joint with synthetic substitute, posterior approach, anterior column, open approach

0SG30K0 Fusion of lumbosacral joint with nonautologous tissue substitute, anterior approach, anterior column, open approach

0SG30K1 Fusion of lumbosacral joint with nonautologous tissue substitute, posterior approach, posterior column, open approach

0SG30KJ Fusion of lumbosacral joint with nonautologous tissue substitute, posterior approach, anterior column, open approach

0SG504Z Fusion of sacrococcygeal joint with internal fixation device, open approach

0SG507Z Fusion of sacrococcygeal joint with autologous tissue substitute, open approach

0SG50JZ Fusion of sacrococcygeal joint with synthetic substitute, open approach

0SG50KZ Fusion of sacrococcygeal joint with nonautologous tissue substitute, open approach

0SG604Z Fusion of coccygeal joint with internal fixation device, open approach

0SG607Z Fusion of coccygeal joint with autologous tissue substitute, open approach

0SG60JZ Fusion of coccygeal joint with synthetic substitute, open approach

0SG60KZ Fusion of coccygeal joint with nonautologous tissue substitute, open approach

Group 1 Codes

Code	Description
XX000	Not Applicable

ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

(1 Code)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
XX000	Not Applicable

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
999x	Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code	Description
99999	Not Applicable

Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
03/28/2024	R3	The article is retired effective for dates of service on and after 03/28/2024. This is in response to an analysis of the article.
01/01/2023	R2	Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT codes either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 22630, 22632, 22633, and 22634 in Group 1 Codes.
01/01/2022	R1	Article revised and published 1/20/2022 effective for dates of service on and after 01/01/2022 to reflect the Annual HCPCS/CPT Code Updates. The following CPT codes have been added to the Article in the CPT/HCPCS Codes, Group 1 Codes: 63052, 63053. A statement was also added to the CPT/HCPCS Codes Group 1 Paragraph to reflect that 63052 and 63053 are add-on codes. For the following Group 1 CPT codes either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 22533, 22534, 22558, 22585, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812. Minor formatting changes have been made throughout the article.

Associated Documents

Related Local Coverage Documents
LCDs
L33382 - Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions

Updated On	Effective Dates	Status
03/28/2024	01/01/2023 - 03/28/2024	Retired	You are here
01/20/2023	01/01/2023 - N/A	Superseded	View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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Billing and Coding: Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions

Document Note

Note History

Contractor Information

Article Information

General Information

CMS National Coverage Policy

Article Guidance

Response To Comments

Coding Information

Bill Type Codes

Revenue Codes

CPT/HCPCS Codes

Group 1

CPT/HCPCS Modifiers

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

ICD-10-PCS Codes

Group 1

Additional ICD-10 Information

Bill Type Codes

Revenue Codes

Other Coding Information

Group 1

Coding Table Information

Revision History Information

Associated Documents

Keywords

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