Universal Clamp Spinal Fixation System
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Universal Clamp ™ Spinal Fixation System 2011 Coding Guide for Physicians and Hospitals Coding for the Universal Clamp System The Universal Clamp System is a temporary implant for use in orthopedic surgery. The system is intended to provide temporary stabilization as a bone anchor during the development of solid boney fusion and aid in the repair of bone fractures. The fusion is performed from a posterior approach. It is posterior segment fusion, i.e., it does not also involve interbody fusion. The clamp is used for thoracic, lumbar and/or sacral fusion, but not cervical. Although labelled for fracture treatment and other types of spinal procedures, the clamp is currently used only for spinal fusion for severe curvature of the spine including kyphosis, scoliosis and extreme lordosis. ICD-9-CM Diagnosis Codes These codes are used for severe spinal curvature: Procedure Codes Description 737.10 kyphosis (acquired) (postural) 737.11 kyphosis due to radiation 737.12 kyphosis, postlaminectomy 737.19 kyphosis, other 737.20 lordosis (acquired) (postural) 737.21 lordosis, postlaminectomy 737.22 lordosis, other postsurgical 737.29 lordosis, other 737.30 scoliosis/kyphoscoliosis, idiopathic 737.32 progressive infantile idiopathic scoliosis 737.33 scoliosis due to radiation 737.34 thoracogenic scoliosis 737.39 kyphoscoliosis/scoliosis, other 737.8 other curvatures of spine 737.9 unspecified curvature of spine 754.2 certain congenital musculoskeletal deformities of spine Note that some of these codes, while valid, may not be sufficiently specific to meet medical necessity criteria in some payers’ medical policies. Insurance coverage polices for treatment of scoliosis vary by payer. Zimmer recommends that you contact your local payers to determine the criteria for spinal fusions for the treatment of scoliosis. Contact the Zimmer Reimbursement Hotline at 866.946.0444 or visit us at www.reimbursement.zimmer.com. The four codes below are also used for spinal curvature. However, these codes can never be assigned as the principal diagnosis. They are only for spinal curvature due to other conditions. The other condition must always be sequenced first. For example, scoliosis due to osteitis deformans (731.0) is coded plus 737.43. Procedure Codes Description 737.40 curvature of spine, unspecified, associated with other conditions 737.41 kyphosis, associated with other conditions 737.42 lordosis, associated with other conditions 737.43 scoliosis, associated with other conditions ICD-9-CM Procedure Codes for Inpatient Hospital Spinal fusion is always coded with a combination of two or three ICD9-9-CM codes. The coding below is only for a posterior T1-S1 approach. The first code is the fusion itself, identified by the spinal region and the approach. The second code shows the number of vertebrae fused. If the fusion involves harvesting autologous bone, a third code is added. There are no separate ICD-9-CM procedures codes for posterior instrumentation or use of allograft bone. > Fusion Procedure Codes Description 81.05 Dorsal and dorsolumbar fusion of the posterior column, posterior technique 81.07 Lumbar and lumbosacral fusion of the posterior column, posterior technique 81.08 Lumbar and lumbosacral fusion of the anterior column, posterior technique (Note: Codes 81.0X are for the initial fusion. Refusion uses codes 81.35, 81.37, 81.38.) > Number of Vertebrae Fused Procedure Codes Description 81.62 Fusion or refusion of 2-3 vertebrae 81.63 Fusion or refusion of 4-8 vertebrae 81.64 Fusion or refusion of 9 or more vertebrae > Harvesting Autologous Bone Procedure Codes Description 77.79 excision of bone for graft, other site (includes harvest from pelvic bones, Insurance coverage polices for treatment of scoliosis vary by payer. Zimmer recommends that you contact your local payers to determine the criteria for spinal fusions for the treatment of scoliosis. Contact the Zimmer Reimbursement Hotline at 866.946.0444 or visit us at www.reimbursement.zimmer.com. MS-DRGs and Payment Rates for Inpatient Hospital There is a distinct set of DRGs just for fusions performed for the various forms of spinal curvature. 2012 Medicare National Average Payment Rate† MS-DRG Description 456 Spinal Fusion Except Cervical with Spinal Curvature/ Malignancy/Infection or 9+ Fusions with MCC $55,271 457 Spinal Fusion Except Cervical with Spinal Curvature/Malignancy/ Infection or 9+ Fusions with CC $35,716 458 Spinal Fusion Except Cervical with Spinal Curvature/Malignancy/ Infection or 9+ Fusions without CC/MCC $28,474 CPT* Codes and Physician Payment Rates CPT fusion coding is set up somewhat differently from ICD-9-CM. In CPT, spinal fusion is shown by a combination of three codes. The coding below is only for a posterior T1-S1 approach. The first code is the fusion itself, identified by the spinal region and the approach. The second code is for the use of instrumentation. Again, only posterior instrumentation codes are shown below. The third code is for laying the bone graft, autograft or allograft. > Fusion 2011 Medicare National Average Payment Rate†† Procedure Codes Description 22800 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments $1,349 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments $2,112 22804 Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments $2,435 *Current Procedural Terminology ©2011 American Medical Association. All Rights Reserved. † FY 2012 Medicare Inpatient Prospective Payment System final rule (CMS-1518-F), Table 5. Assumes payment for a large urban hospital with wage index >1 and full update. Medicare payment = MSDRG relative weight x (labor standardized amount +non-labor standardized amount + national capital rate.) †† Per CMS-1503-N2 determined by multiplying the physician fee schedule conversion factor ($33.9764) by the total adjusted facility RVUs. Represents national average with no geographic adjustment; individual physician reimbursement will vary. Insurance coverage polices for treatment of scoliosis vary by payer. Zimmer recommends that you contact your local payers to determine the criteria for spinal fusions for the treatment of scoliosis. Contact the Zimmer Reimbursement Hotline at 866.946.0444 or visit us at www.reimbursement.zimmer.com. > Instrumentation Procedure Codes Description 2011 Medicare National Average Payment Rate†† 22840 Posterior non-segmental instrumentation (e.g., Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 22841 Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) 22842 Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) $780 22843 Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure) $828 22844 Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure) $1,000 $778 $0 Note: The instrumentation codes are add-ons and cannot be used alone. They must always be used with the spinal fusion codes or other related procedure codes. > Bone Graft Procedure Codes Description 2011 Medicare National Average Payment Rate†† 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) $114 20936 Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) $0 20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) $171 20938 Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure) $188 $0 Note: The bone graft instrumentation codes are add-ons and cannot be used alone. They must always be used with the spinal fusion codes or other related procedure codes. *Current Procedural Terminology ©2011 American Medical Association. All Rights Reserved. †† Per CMS-1503-N2 determined by multiplying the physician fee schedule conversion factor ($33.9764) by the total adjusted facility RVUs. Represents national average with no geographic adjustment; individual physician reimbursement will vary. Insurance coverage polices for treatment of scoliosis vary by payer. Zimmer recommends that you contact your local payers to determine the criteria for spinal fusions for the treatment of scoliosis. Contact the Zimmer Reimbursement Hotline at 866.946.0444 or visit us at www.reimbursement.zimmer.com. Notes/Disclaimers This Coding Reference Guide is intended to illustrate the common CPT®* codes, ICD-9 CM procedure codes, and common MS-DRG, APC and ASC assignment for spine product and procedures performed in the inpatient hospital, outpatient hospital, and ambulatory surgical center settings. The bookmarks in this document include physician and hospital coding information organized by Zimmer product, followed by several spinal coding scenarios and examples. To find potential codes for Zimmer products, click on the “Product Coding” bookmarks. Current Procedural Terminology (CPT) is copyright 2011 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. ICD-9-CM Official Guidelines For Coding and Reporting, U.S. Department of Health and Human Services, Effective October 1, 2010. Zimmer Coding Reference Guide Disclaimer — Limitation on Coverage and Payment The information in this document was obtained from third party sources and is subject to change without notice, including as a result of changes in reimbursement laws, regulations, rules and policies. All content in this document is informational only, general in nature and does not cover all situations or all payers’ rules or policies. The service and the product must be reasonable and necessary for the care of the patient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patients’ medical condition, procedures performed and the products used. This document represents no promise or guarantee by Zimmer regarding coverage or payment for products or procedures by Medicare or other payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the hospital’s Medicare Part A fiscal intermediary, the physician’s Medicare Part B carrier, or to appropriate payers. Zimmer specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. Solutions by the people of Zimmer Spine. You are devoted to helping your patients reduce their pain and improve their lives. And the people of Zimmer Spine are devoted to you. We are dedicated to supporting you with best-in-class tools, instruments and implants. We are driven by the opportunity to share our unrivaled education and training. We are committed partners who will do everything in our power to assist you in your quest to provide the absolute best in spinal care. And we can be counted on always to act with integrity as ethical partners who are worthy of your trust. We are the people of Zimmer Spine. 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